Provider Demographics
NPI:1467860577
Name:CHASTAIN, KATHY JILL (LMFT)
Entity type:Individual
Prefix:
First Name:KATHY
Middle Name:JILL
Last Name:CHASTAIN
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:CALIFORNIA
Other - Middle Name:CHRISTIAN
Other - Last Name:COUNSELING
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MA, LMFT
Mailing Address - Street 1:246 W CALDWELL AVE
Mailing Address - Street 2:
Mailing Address - City:VISALIA
Mailing Address - State:CA
Mailing Address - Zip Code:93277-3771
Mailing Address - Country:US
Mailing Address - Phone:559-991-7715
Mailing Address - Fax:
Practice Address - Street 1:246 W CALDWELL AVE
Practice Address - Street 2:
Practice Address - City:VISALIA
Practice Address - State:CA
Practice Address - Zip Code:93277-3771
Practice Address - Country:US
Practice Address - Phone:559-991-7715
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-01
Last Update Date:2024-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA114064106H00000X
CAIMF84451106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA114064OtherBOARD OF BEHAVIORAL SCIENCES