Provider Demographics
NPI:1174747620
Name:CHAIYARAT, PEARL (LMFT)
Entity type:Individual
Prefix:
First Name:PEARL
Middle Name:
Last Name:CHAIYARAT
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:PO BOX 106
Mailing Address - Street 2:
Mailing Address - City:FELTON
Mailing Address - State:CA
Mailing Address - Zip Code:95018-0106
Mailing Address - Country:US
Mailing Address - Phone:831-454-1702
Mailing Address - Fax:
Practice Address - Street 1:240 WESTGATE DR
Practice Address - Street 2:SUITE 123
Practice Address - City:WATSONVILLE
Practice Address - State:CA
Practice Address - Zip Code:95076-2461
Practice Address - Country:US
Practice Address - Phone:831-454-1702
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-13
Last Update Date:2010-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 48347106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist