Provider Demographics
NPI:1952757908
Name:LANDEROS, CHANTEL B (LMFT)
Entity Type:Individual
Prefix:
First Name:CHANTEL
Middle Name:B
Last Name:LANDEROS
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:CHANTEL
Other - Middle Name:B
Other - Last Name:LANDEROS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:715 HORIZON DR STE 225
Mailing Address - Street 2:
Mailing Address - City:GRAND JUNCTION
Mailing Address - State:CO
Mailing Address - Zip Code:81506-8743
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2526 PATTERSON RD UNIT 200
Practice Address - Street 2:
Practice Address - City:GRAND JUNCTION
Practice Address - State:CO
Practice Address - Zip Code:81505-1146
Practice Address - Country:US
Practice Address - Phone:970-812-1292
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-05-09
Last Update Date:2022-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COMFT.0002042106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist