Provider Demographics
NPI:1669167771
Name:CHAN, IVAN WAH-CHIANG (LMFT)
Entity type:Individual
Prefix:MR
First Name:IVAN
Middle Name:WAH-CHIANG
Last Name:CHAN
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1174
Mailing Address - Street 2:
Mailing Address - City:SANTA BARBARA
Mailing Address - State:CA
Mailing Address - Zip Code:93102-1174
Mailing Address - Country:US
Mailing Address - Phone:831-607-9773
Mailing Address - Fax:
Practice Address - Street 1:1771 POLI ST
Practice Address - Street 2:
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:93001-2364
Practice Address - Country:US
Practice Address - Phone:831-607-9773
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-06
Last Update Date:2023-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALMFT82584106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist