Healthcare Provider Details

I. General information

NPI: 1811721889
Provider Name (Legal Business Name): EMILY CHANE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/30/2024
Last Update Date: 07/10/2026
Certification Date: 07/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

650 SPRING OAK RD UNIT 821
CAMARILLO CA
93010-7543
US

IV. Provider business mailing address

650 SPRING OAK RD UNIT 821
CAMARILLO CA
93010-7543
US

V. Phone/Fax

Practice location:
  • Phone: 818-439-0303
  • Fax:
Mailing address:
  • Phone: 818-439-0303
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number164438
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: