MEDICARE: CHANELLE ATSYOR LAPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	008176	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1134886070
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHANELLE ATSYOR LAPC

Provider Business Mailing Address
First Line	:	1808 OVER LAKE DR SE
Second Line	:
City	:	CONYERS
State	:	GA
Zip	:	30013-6608
Country	:	US
Telephone Number	:	678-806-3468
Fax Number	:

Provider Business Practice Location Address
First Line	:	1808 OVER LAKE DR SE
Second Line	:
City	:	CONYERS
State	:	GA
Zip	:	30013-6608
Country	:	US
Telephone Number	:	678-806-3468
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/28/2021
Last Update Date	:	11/28/2021

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Directions to “ CHANELLE ATSYOR LAPC” Practice Location

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