Basic Information
| Provider Information | |||||||||
| NPI: | 1427461227 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CHEA | ||||||||
| FirstName: | BORYA | ||||||||
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| Credential: | ACSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 15400 SHERMAN WAY STE 220 | ||||||||
| Address2: | |||||||||
| City: | VAN NUYS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 914067403 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8182671100 | ||||||||
| FaxNumber: | 2133833146 | ||||||||
| Practice Location | |||||||||
| Address1: | 15400 SHERMAN WAY STE 220 | ||||||||
| Address2: | |||||||||
| City: | VAN NUYS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 914067403 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8182671100 | ||||||||
| FaxNumber: | 2133833146 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/09/2014 | ||||||||
| LastUpdateDate: | 01/16/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 01/16/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | ASW60333 | CA | N | Behavioral Health & Social Service Providers | Counselor | Mental Health | 225400000X | CA | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Rehabilitation Practitioner | 101YM0800X | 93739 | CA | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.