MEDICARE: MARTHA CHACON LMFT

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
2	106H00000X	Marriage & Family Therapist	107148	CA

General Provider Information

NPI Number	:	1750415212
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARTHA CHACON LMFT

Provider Business Mailing Address
First Line	:	828 HIGH ST STE C
Second Line	:
City	:	DELANO
State	:	CA
Zip	:	93215-2960
Country	:	US
Telephone Number	:	661-725-2788
Fax Number	:	661-725-1957

Provider Business Practice Location Address
First Line	:	1168 LELAND AVE
Second Line	:
City	:	TULARE
State	:	CA
Zip	:	93274-7811
Country	:	US
Telephone Number	:	559-759-3971
Fax Number	:

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

Provider Enumeration Date	:	03/15/2007
Last Update Date	:	02/04/2025

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