Provider Demographics
NPI:1437902509
Name:CHOURA, AUDREY (LCSW)
Entity Type:Individual
Prefix:
First Name:AUDREY
Middle Name:
Last Name:CHOURA
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:929 BLUE HERON
Mailing Address - Street 2:
Mailing Address - City:SEAL BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90740-5611
Mailing Address - Country:US
Mailing Address - Phone:562-204-6634
Mailing Address - Fax:
Practice Address - Street 1:4132 KATELLA AVE STE 206
Practice Address - Street 2:
Practice Address - City:LOS ALAMITOS
Practice Address - State:CA
Practice Address - Zip Code:90720-6603
Practice Address - Country:US
Practice Address - Phone:562-204-6634
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-09
Last Update Date:2024-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1204961041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical