Active NPI
Erica Chestnut, MC, LISAC
- Counselor
- Glendale, AZ
National Provider Identifier
1215124334
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Counselor
- License
- LISAC-10600
- Practice address
- 4425 W Olive Ave
194
Glendale, AZ 85302-3843 - Phone
- (480) 262-0508
- Fax
- (602) 629-1536
- NPI assigned
- Oct 2, 2007
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Counselor | 101Y00000X | LISAC-10600 | AZ | Primary |
Addresses
Primary practice location
4425 W Olive Ave
194
Glendale, AZ 85302-3843
Mailing address
4425 W Olive Ave
194
Glendale, AZ 85302-3843
Phone (480) 262-0508
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| LISAC-10600 | AZ | MD | Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1191283200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1191283200000",
"number": "1215124334",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4425 W OLIVE AVE",
"address_2": "194",
"city": "GLENDALE",
"state": "AZ",
"postal_code": "853023843",
"telephone_number": "480-262-0508",
"fax_number": "602-629-1536"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4425 W OLIVE AVE",
"address_2": "194",
"city": "GLENDALE",
"state": "AZ",
"postal_code": "853023843",
"telephone_number": "480-262-0508",
"fax_number": "602-629-1536"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CHESTNUT",
"first_name": "ERICA",
"name_prefix": "Ms.",
"credential": "MC, LISAC",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-10-02",
"last_updated": "2007-10-02",
"status": "A"
},
"taxonomies": [
{
"code": "101Y00000X",
"taxonomy_group": "",
"desc": "Counselor",
"state": "AZ",
"license": "LISAC-10600",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Glendale, AZ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 2, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.