Healthcare Provider Details

I. General information

NPI: 1801090725
Provider Name (Legal Business Name): KELLIE M CHAPMAN LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/13/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

605 SW PARK ST STE 203
OKEECHOBEE FL
34972-4173
US

IV. Provider business mailing address

605 SW PARK ST STE 203
OKEECHOBEE FL
34972-4173
US

V. Phone/Fax

Practice location:
  • Phone: 863-634-7226
  • Fax:
Mailing address:
  • Phone: 863-634-7226
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH9063
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: