Individual
CHASTIDY MARIAH CHACON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NCC, LPC
Contact information
Practice address
5401 W 10TH ST STE 200, GREELEY, CO 80634-4468
(970) 310-3406
Mailing address
PO BOX 514, LA JARA, CO 81140-0514
(469) 810-2021
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
LPC.0018539
CO
101YP2500X
Professional Counselor
Primary
LPC.0018539
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1461830
NBCC
—
Enumeration date
10/11/2022
Last updated
11/15/2024
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