Provider Demographics
NPI:1942552781
Name:CHUDLER, HOWARD (MFT)
Entity Type:Individual
Prefix:DR
First Name:HOWARD
Middle Name:
Last Name:CHUDLER
Suffix:
Gender:M
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:626 W ROUTE 66 STE E
Mailing Address - Street 2:
Mailing Address - City:GLENDORA
Mailing Address - State:CA
Mailing Address - Zip Code:91740-4167
Mailing Address - Country:US
Mailing Address - Phone:714-529-2549
Mailing Address - Fax:714-529-2532
Practice Address - Street 1:626 W ROUTE 66 STE E
Practice Address - Street 2:
Practice Address - City:GLENDORA
Practice Address - State:CA
Practice Address - Zip Code:91740-4167
Practice Address - Country:US
Practice Address - Phone:714-529-2549
Practice Address - Fax:714-529-2532
Is Sole Proprietor?:No
Enumeration Date:2012-10-03
Last Update Date:2012-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAM15813101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health