Provider Demographics
NPI:1750337630
Name:MIHM, CHANTAL NATHALIE (PSYD)
Entity type:Individual
Prefix:DR
First Name:CHANTAL
Middle Name:NATHALIE
Last Name:MIHM
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:HEALTH PSYCH MAINE, LLC
Mailing Address - Street 2:2 BIG SKY LANE
Mailing Address - City:WATERVILLE
Mailing Address - State:ME
Mailing Address - Zip Code:04901
Mailing Address - Country:US
Mailing Address - Phone:207-872-5800
Mailing Address - Fax:207-872-5888
Practice Address - Street 1:3801 MIRANDA AVE
Practice Address - Street 2:VA PALO ALTO HCS (116B)
Practice Address - City:PALO ALTO
Practice Address - State:CA
Practice Address - Zip Code:94304-1207
Practice Address - Country:US
Practice Address - Phone:650-493-5000
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-25
Last Update Date:2018-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY17847103TC0700X
MEPS1161103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical