Provider Demographics
NPI:1982888533
Name:CHICHESTER, BRIAN M (PSYD, MPH)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:M
Last Name:CHICHESTER
Suffix:
Gender:M
Credentials:PSYD, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:339 CAJON ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:REDLANDS
Mailing Address - State:CA
Mailing Address - Zip Code:92373-5901
Mailing Address - Country:US
Mailing Address - Phone:909-363-6263
Mailing Address - Fax:909-307-6536
Practice Address - Street 1:339 CAJON ST
Practice Address - Street 2:SUITE B
Practice Address - City:REDLANDS
Practice Address - State:CA
Practice Address - Zip Code:92373-5901
Practice Address - Country:US
Practice Address - Phone:909-363-6263
Practice Address - Fax:909-307-6536
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-18
Last Update Date:2007-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY 21544103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical