MEDICARE: DAWN CHANDLER MFT INTERN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106H00000X	Marriage & Family Therapist	IMF87531	CA

General Provider Information

NPI Number	:	1184009250
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAWN CHANDLER MFT INTERN

Provider Business Mailing Address
First Line	:	301 SCIENCE DR
Second Line	:	SUITE 120
City	:	MOORPARK
State	:	CA
Zip	:	93021-2094
Country	:	US
Telephone Number	:	805-501-9296
Fax Number	:

Provider Business Practice Location Address
First Line	:	301 SCIENCE DR
Second Line	:	SUITE 120
City	:	MOORPARK
State	:	CA
Zip	:	93021-2094
Country	:	US
Telephone Number	:	805-501-9296
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/29/2015
Last Update Date	:	07/29/2015

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