Provider Demographics
NPI:1902274228
Name:LAM, CHANDA (LMFT)
Entity Type:Individual
Prefix:
First Name:CHANDA
Middle Name:
Last Name:LAM
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9171 WILSHIRE BLVD
Mailing Address - Street 2:PENTHOUSE
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90210-5530
Mailing Address - Country:US
Mailing Address - Phone:310-935-1867
Mailing Address - Fax:
Practice Address - Street 1:9171 WILSHIRE BLVD
Practice Address - Street 2:PENTHOUSE
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90210-5530
Practice Address - Country:US
Practice Address - Phone:310-935-1867
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-02
Last Update Date:2015-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA84395106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist