Healthcare Provider Details

I. General information

NPI: 1225553910
Provider Name (Legal Business Name): CAC CHESTNUT TODDLER CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/03/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 W CHESTNUT AVE
LOMPOC CA
93436-5913
US

IV. Provider business mailing address

120 W CHESTNUT AVE
LOMPOC CA
93436-5913
US

V. Phone/Fax

Practice location:
  • Phone: 805-740-4555
  • Fax: 805-740-4558
Mailing address:
  • Phone: 805-740-4555
  • Fax: 805-740-4558

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number28718
License Number StateCA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier1457553174
Identifier TypeMEDICAID
Identifier StateCA
Identifier Issuer

VIII. Authorized Official

Name: DR. DAVID LAUREL SCOTT
Title or Position: CLINICAL SERVICES DIRECTOR
Credential: PSY.D., LMFT
Phone: 805-260-4676