MEDICARE: CHANDRA CHAIKIN MS LICENSEDMARRIAGE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225600000X	Dance Therapist
2	106H00000X	Marriage & Family Therapist

General Provider Information

NPI Number	:	1720896269
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHANDRA CHAIKIN MS LICENSEDMARRIAGE

Provider Business Mailing Address
First Line	:	25401 CABOT RD STE 115
Second Line	:
City	:	LAGUNA HILLS
State	:	CA
Zip	:	92653-5530
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	25401 CABOT RD STE 115
Second Line	:
City	:	LAGUNA HILLS
State	:	CA
Zip	:	92653-5530
Country	:	US
Telephone Number	:	949-215-0612
Fax Number	:	949-215-0636

Authorized Official
Title or Position	:	OWNER
Name	:	CHANDRA BAYLOR
Credential	:	MFT, BC-DMT, CEDS
Telephone Number	:	949-215-0612

Provider Enumeration Date	:	12/30/2024
Last Update Date	:	05/12/2025

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