Provider Demographics
NPI:1942737184
Name:CHACON, JORGE (PSYD)
Entity Type:Individual
Prefix:DR
First Name:JORGE
Middle Name:
Last Name:CHACON
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:766 S MISSION ST
Mailing Address - Street 2:
Mailing Address - City:WENATCHEE
Mailing Address - State:WA
Mailing Address - Zip Code:98801-3052
Mailing Address - Country:US
Mailing Address - Phone:509-667-1926
Mailing Address - Fax:509-888-3001
Practice Address - Street 1:766 S MISSION ST
Practice Address - Street 2:
Practice Address - City:WENATCHEE
Practice Address - State:WA
Practice Address - Zip Code:98801-3052
Practice Address - Country:US
Practice Address - Phone:509-667-1926
Practice Address - Fax:509-888-3001
Is Sole Proprietor?:No
Enumeration Date:2017-05-18
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACL60173043101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health