Provider Demographics
NPI:1689220634
Name:MOLTANE, CHAD CONDON (MA, LPC, PHD DOCTOR)
Entity Type:Individual
Prefix:MR
First Name:CHAD
Middle Name:CONDON
Last Name:MOLTANE
Suffix:
Gender:M
Credentials:MA, LPC, PHD DOCTOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5143 TIMBERWOLF DRIVE
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79903
Mailing Address - Country:US
Mailing Address - Phone:915-248-7814
Mailing Address - Fax:
Practice Address - Street 1:5048 LOVE ROAD
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79922
Practice Address - Country:US
Practice Address - Phone:915-740-3698
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-15
Last Update Date:2019-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX73-180101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional