Provider Demographics
NPI:1598223554
Name:CHUDNOW, ALAN
Entity Type:Individual
Prefix:MR
First Name:ALAN
Middle Name:
Last Name:CHUDNOW
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3020 OLD RANCH PKWY STE 300
Mailing Address - Street 2:
Mailing Address - City:SEAL BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90740-2751
Mailing Address - Country:US
Mailing Address - Phone:562-448-2001
Mailing Address - Fax:
Practice Address - Street 1:3020 OLD RANCH PKWY
Practice Address - Street 2:
Practice Address - City:SEAL BEACH
Practice Address - State:CA
Practice Address - Zip Code:90740-2765
Practice Address - Country:US
Practice Address - Phone:562-448-2001
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-08
Last Update Date:2019-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAMFT111770106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist