Healthcare Provider Details

I. General information

NPI: 1720896269
Provider Name (Legal Business Name): CHANDRA CHAIKIN MS LICENSEDMARRIAGE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/30/2024
Last Update Date: 05/12/2025
Certification Date: 05/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25401 CABOT RD STE 115
LAGUNA HILLS CA
92653-5530
US

IV. Provider business mailing address

25401 CABOT RD STE 115
LAGUNA HILLS CA
92653-5530
US

V. Phone/Fax

Practice location:
  • Phone: 949-215-0612
  • Fax: 949-215-0636
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225600000X
TaxonomyDance Therapist
License Number
License Number State

VIII. Authorized Official

Name: CHANDRA BAYLOR
Title or Position: OWNER
Credential: MFT, BC-DMT, CEDS
Phone: 949-215-0612