Provider Demographics
NPI:1740636489
Name:WUNDERLICH, CHANTAL CLAUDIA (MA, MFT)
Entity type:Individual
Prefix:
First Name:CHANTAL
Middle Name:CLAUDIA
Last Name:WUNDERLICH
Suffix:
Gender:F
Credentials:MA, MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:976 MEDIO RD
Mailing Address - Street 2:
Mailing Address - City:SANTA BARBARA
Mailing Address - State:CA
Mailing Address - Zip Code:93103-2446
Mailing Address - Country:US
Mailing Address - Phone:805-640-5570
Mailing Address - Fax:
Practice Address - Street 1:976 MEDIO RD
Practice Address - Street 2:
Practice Address - City:SANTA BARBARA
Practice Address - State:CA
Practice Address - Zip Code:93103-2446
Practice Address - Country:US
Practice Address - Phone:805-640-5570
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-12
Last Update Date:2016-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA90894106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist