Healthcare Provider Details

I. General information

NPI: 1437651254
Provider Name (Legal Business Name): CHANTAL ASADOOR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/07/2018
Last Update Date: 09/17/2026
Certification Date: 09/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

420 E CANAL DR
TURLOCK CA
95380-3936
US

IV. Provider business mailing address

2401 E ORANGEBURG AVE STE 675120
MODESTO CA
95355-3351
US

V. Phone/Fax

Practice location:
  • Phone: 209-669-2583
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number17-45942
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: