Healthcare Provider Details

I. General information

NPI: 1497315246
Provider Name (Legal Business Name): LYNDA LABIE CHASSLER LCSW; PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/14/2019
Last Update Date: 06/14/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9615 BRIGHTON WAY STE 230
BEVERLY HILLS CA
90210-5118
US

IV. Provider business mailing address

9615 BRIGHTON WAY STE 230
BEVERLY HILLS CA
90210-5118
US

V. Phone/Fax

Practice location:
  • Phone: 310-858-5978
  • Fax:
Mailing address:
  • Phone: 310-858-5978
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLC007357
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: