Provider Demographics
NPI:1861160533
Name:CHANEY, LUCILLE MARIE
Entity type:Individual
Prefix:
First Name:LUCILLE
Middle Name:MARIE
Last Name:CHANEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23166 LOS ALISOS BLVD STE 108-107
Mailing Address - Street 2:
Mailing Address - City:MISSION VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92691-2835
Mailing Address - Country:US
Mailing Address - Phone:949-459-4680
Mailing Address - Fax:949-625-2920
Practice Address - Street 1:30021 TOMAS STE 300
Practice Address - Street 2:
Practice Address - City:RANCHO SANTA MARGARITA
Practice Address - State:CA
Practice Address - Zip Code:92688-2128
Practice Address - Country:US
Practice Address - Phone:949-459-4680
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-30
Last Update Date:2025-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1289731041C0700X
CA109594104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker