Provider Demographics
NPI:1558794016
Name:CHIVERTON, CHUCK THOMAS (LPC BHP)
Entity Type:Individual
Prefix:DR
First Name:CHUCK
Middle Name:THOMAS
Last Name:CHIVERTON
Suffix:
Gender:M
Credentials:LPC BHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3131 N COUNTRY CLUB RD STE 101
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85716-1650
Mailing Address - Country:US
Mailing Address - Phone:520-325-9498
Mailing Address - Fax:
Practice Address - Street 1:3131 N COUNTRY CLUB RD STE 101
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85716-1650
Practice Address - Country:US
Practice Address - Phone:520-325-9498
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-19
Last Update Date:2013-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLPC-10044101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional