MEDICARE: TANYATTA CHATEAU LCSW, MSG

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	1041C0700X	Clinical Social Worker	23309	CA

General Provider Information

NPI Number	:	1598083784
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TANYATTA CHATEAU LCSW, MSG

Provider Business Mailing Address
First Line	:	PO BOX 8221
Second Line	:
City	:	MISSION HILLS
State	:	CA
Zip	:	91346-8221
Country	:	US
Telephone Number	:	818-606-9836
Fax Number	:

Provider Business Practice Location Address
First Line	:	8363 RESEDA BLVD
Second Line	:	SUITE #203 E
City	:	NORTHRIDGE
State	:	CA
Zip	:	91324-4623
Country	:	US
Telephone Number	:	818-606-9836
Fax Number	:

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

Provider Enumeration Date	:	05/12/2010
Last Update Date	:	06/06/2014

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