Provider Demographics
NPI:1710337902
Name:CHABOT-FENCE, MARYANN (MFT)
Entity Type:Individual
Prefix:
First Name:MARYANN
Middle Name:
Last Name:CHABOT-FENCE
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5959 SEDGE RD
Mailing Address - Street 2:
Mailing Address - City:CARSON CITY
Mailing Address - State:NV
Mailing Address - Zip Code:89701-9303
Mailing Address - Country:US
Mailing Address - Phone:775-720-8090
Mailing Address - Fax:
Practice Address - Street 1:5959 SEDGE RD
Practice Address - Street 2:
Practice Address - City:CARSON CITY
Practice Address - State:NV
Practice Address - Zip Code:89701-9303
Practice Address - Country:US
Practice Address - Phone:775-720-8090
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-17
Last Update Date:2016-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV0840101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health