Healthcare Provider Details

I. General information

NPI: 1467710509
Provider Name (Legal Business Name): SHAUN CHESNUT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/26/2012
Last Update Date: 02/09/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

365 WHISKEYHILL RD.
WATSONVILLE CA
95076
US

IV. Provider business mailing address

365 WHISKEYHILL RD.
WATSONVILLE CA
95076
US

V. Phone/Fax

Practice location:
  • Phone: 831-724-9333
  • Fax:
Mailing address:
  • Phone: 831-724-9333
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: