Provider Demographics
NPI:1548760879
Name:HART, CHANTAL ANNETTE
Entity Type:Individual
Prefix:MRS
First Name:CHANTAL
Middle Name:ANNETTE
Last Name:HART
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1823 NE 8TH AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97212-3907
Mailing Address - Country:US
Mailing Address - Phone:503-460-2796
Mailing Address - Fax:
Practice Address - Street 1:1823 NE 8TH AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97212-3907
Practice Address - Country:US
Practice Address - Phone:503-460-2796
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-13
Last Update Date:2018-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist