Provider Demographics
NPI:1023238524
Name:KASPAR, CHUCK (MFT)
Entity type:Individual
Prefix:
First Name:CHUCK
Middle Name:
Last Name:KASPAR
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 1:3140 DE LA CRUZ BLVD
Mailing Address - Street 2:S200
Mailing Address - City:SANTA CLARA
Mailing Address - State:CA
Mailing Address - Zip Code:95054
Mailing Address - Country:US
Mailing Address - Phone:408-988-1182
Mailing Address - Fax:408-970-4204
Practice Address - Street 1:3140 DE LA CRUZ BLVD
Practice Address - Street 2:S200
Practice Address - City:SANTA CLARA
Practice Address - State:CA
Practice Address - Zip Code:95054
Practice Address - Country:US
Practice Address - Phone:408-988-1182
Practice Address - Fax:408-970-4204
Is Sole Proprietor?:No
Enumeration Date:2007-04-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFT17395106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist