Basic Information
| Provider Information | |||||||||
| NPI: | 1184764581 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CHUBBS | ||||||||
| FirstName: | MYKESHA | ||||||||
| MiddleName: | FEMI | ||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | B.A | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1430 E COOLEY DR STE 240 | ||||||||
| Address2: | |||||||||
| City: | COLTON | ||||||||
| State: | CA | ||||||||
| PostalCode: | 923243936 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9094330445 | ||||||||
| FaxNumber: | 9094330556 | ||||||||
| Practice Location | |||||||||
| Address1: | 440 CAJON ST | ||||||||
| Address2: | |||||||||
| City: | REDLANDS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 923735955 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9093075777 | ||||||||
| FaxNumber: | 9093075776 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/07/2007 | ||||||||
| LastUpdateDate: | 04/18/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | N | Behavioral Health & Social Service Providers | Counselor | Mental Health | 106H00000X | Y | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
No ID Information.