Provider Demographics
NPI:1245660760
Name:CHISHOLM, CLARE L (MA, LCPC (MT))
Entity type:Individual
Prefix:
First Name:CLARE
Middle Name:L
Last Name:CHISHOLM
Suffix:
Gender:F
Credentials:MA, LCPC (MT)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:941 WESTWOOD BLVD.
Mailing Address - Street 2:SUITE 206
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90024
Mailing Address - Country:US
Mailing Address - Phone:323-770-2854
Mailing Address - Fax:
Practice Address - Street 1:941 WESTWOOD BLVD
Practice Address - Street 2:SUITE 206
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90024
Practice Address - Country:US
Practice Address - Phone:323-770-2854
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-19
Last Update Date:2013-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246Z00000XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, Other