Provider Demographics
NPI:1295520906
Name:MUCCI, CHANEL CHRISTINE (MA, LMFT)
Entity type:Individual
Prefix:
First Name:CHANEL
Middle Name:CHRISTINE
Last Name:MUCCI
Suffix:
Gender:
Credentials:MA, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:513 FAIR OAKS AVE APT F
Mailing Address - Street 2:
Mailing Address - City:SOUTH PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91030-1840
Mailing Address - Country:US
Mailing Address - Phone:626-590-7458
Mailing Address - Fax:
Practice Address - Street 1:1555 W SUNSET BLVD STE C
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90026-7521
Practice Address - Country:US
Practice Address - Phone:323-388-3316
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-12
Last Update Date:2025-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA154318101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health