=====================================================
General NPI Number Information
=====================================================
NPI Number | 1861160533
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LUCILLE MARIE CHANEY
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/30/2021
-----------------------------------------------------
Last Update Date | 12/30/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3420 BRISTOL ST # 306
-----------------------------------------------------
City | COSTA MESA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92626-7170
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 949-459-4680
-----------------------------------------------------
Fax | 949-625-2920
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 23166 LOS ALISOS BLVD STE 108-107
-----------------------------------------------------
City | MISSION VIEJO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92691-2835
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 949-459-4680
-----------------------------------------------------
Fax | 949-625-2920
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | 128973
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------