Provider Demographics
NPI:1740031814
Name:CHISM, HUNTER MCNABB
Entity type:Individual
Prefix:
First Name:HUNTER
Middle Name:MCNABB
Last Name:CHISM
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:611 HOVEY WAY
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95678-7546
Mailing Address - Country:US
Mailing Address - Phone:916-709-5998
Mailing Address - Fax:
Practice Address - Street 1:30101 SUNSET BLVD SUIT 1A
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95677
Practice Address - Country:US
Practice Address - Phone:916-773-0211
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-28
Last Update Date:2024-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician