Provider Demographics
NPI:1629146758
Name:CHANTIRI, KATIA ANIS (LMHC)
Entity Type:Individual
Prefix:MS
First Name:KATIA
Middle Name:ANIS
Last Name:CHANTIRI
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6651 WELLINGTON PLACE LN
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32216-5068
Mailing Address - Country:US
Mailing Address - Phone:904-924-1550
Mailing Address - Fax:904-924-1544
Practice Address - Street 1:1110 EDGEWOOD AVE W
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32208-6405
Practice Address - Country:US
Practice Address - Phone:904-924-1550
Practice Address - Fax:904-924-1544
Is Sole Proprietor?:No
Enumeration Date:2006-11-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH7782101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health