Provider Demographics
NPI:1609955699
Name:CHESNEY, ALLEN DEWAYNE (AMFT APCC FORMER IDC)
Entity Type:Individual
Prefix:MR
First Name:ALLEN
Middle Name:DEWAYNE
Last Name:CHESNEY
Suffix:
Gender:M
Credentials:AMFT APCC FORMER IDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 E GILBERT STREET FAST
Mailing Address - Street 2:
Mailing Address - City:SAN BERNARDINO
Mailing Address - State:CA
Mailing Address - Zip Code:92415-0001
Mailing Address - Country:US
Mailing Address - Phone:601-527-7537
Mailing Address - Fax:909-386-0750
Practice Address - Street 1:937 VIA LATA STE 400
Practice Address - Street 2:
Practice Address - City:COLTON
Practice Address - State:CA
Practice Address - Zip Code:92324-3958
Practice Address - Country:US
Practice Address - Phone:601-527-7537
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-02
Last Update Date:2021-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAPCC6769101YM0800X
1710I1002X
CAAMFT109669106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1609955699Medicaid