Provider Demographics
NPI:1477909091
Name:CHANCE, JON (LMFT)
Entity Type:Individual
Prefix:
First Name:JON
Middle Name:
Last Name:CHANCE
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:582 MARKET ST
Mailing Address - Street 2:SUITE 1110
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94104-5301
Mailing Address - Country:US
Mailing Address - Phone:415-234-3797
Mailing Address - Fax:
Practice Address - Street 1:582 MARKET ST
Practice Address - Street 2:SUITE 1110
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94104-5301
Practice Address - Country:US
Practice Address - Phone:415-234-3797
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-12
Last Update Date:2016-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA79101106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist