MEDICARE: CRISTINE D CHASTAIN LCSW

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	LCSW21618	CA

General Provider Information

NPI Number	:	1811072598
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CRISTINE D CHASTAIN LCSW

Provider Business Mailing Address
First Line	:	23120 ALICIA PKWY STE 236
Second Line	:
City	:	MISSION VIEJO
State	:	CA
Zip	:	92692-1210
Country	:	US
Telephone Number	:	949-235-2952
Fax Number	:	801-494-2952

Provider Business Practice Location Address
First Line	:	23120 ALICIA PKWY
Second Line	:	SUITE 200
City	:	MISSION VIEJO
State	:	CA
Zip	:	92692-1210
Country	:	US
Telephone Number	:	949-235-2952
Fax Number	:	801-494-2952

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

Provider Enumeration Date	:	10/25/2006
Last Update Date	:	02/25/2025

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