Individual
CHANEL DYAN PETRASEK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
20331 BLUFFSIDE CIR APT 220, HUNTINGTON BEACH, CA 92646-8581
(602) 460-8190
Mailing address
20331 BLUFFSIDE CIR APT 220, HUNTINGTON BEACH, CA 92646-8581
(602) 460-8190
Taxonomy
Speciality
Code
Description
License number
State
106E00000X
Assistant Behavior Analyst
Primary
—
—
Other
Enumeration date
09/14/2019
Last updated
09/14/2019
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