MEDICARE: MS. CHANDRA EUCALYPTUS BAYLOR MFT, BC-DMT, CEDS

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	MFT43942	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	3632960	OTHER	CA	CHANDRA CHAIKIN, MS, LICENSED MARRIAGE FAMILY THERAPY, APC

General Provider Information

NPI Number	:	1215959408
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. CHANDRA EUCALYPTUS BAYLOR MFT, BC-DMT, CEDS

Provider Business Mailing Address
First Line	:	25401 CABOT RD STE 115
Second Line	:
City	:	LAGUNA HILLS
State	:	CA
Zip	:	92653-5530
Country	:	US
Telephone Number	:	949-215-0612
Fax Number	:	949-215-0636

Provider Business Practice Location Address
First Line	:	25401 CABOT RD STE 115
Second Line	:
City	:	LAGUNA HILLS
State	:	CA
Zip	:	92653-5530
Country	:	US
Telephone Number	:	949-215-0612
Fax Number	:	949-215-0636

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

Provider Enumeration Date	:	07/24/2006
Last Update Date	:	12/20/2024

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