Provider Demographics
NPI:1043313349
Name:CHASTAIN, STEPHANIE WADE (MFT)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:WADE
Last Name:CHASTAIN
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1671
Mailing Address - Street 2:
Mailing Address - City:MONTEREY
Mailing Address - State:CA
Mailing Address - Zip Code:93942-1671
Mailing Address - Country:US
Mailing Address - Phone:831-375-4860
Mailing Address - Fax:831-375-1509
Practice Address - Street 1:214 W. FRANKLIN STREET
Practice Address - Street 2:SUITE 406
Practice Address - City:MONTEREY
Practice Address - State:CA
Practice Address - Zip Code:93940
Practice Address - Country:US
Practice Address - Phone:831-375-4860
Practice Address - Fax:831-375-1509
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFT24844101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health