Healthcare Provider Details

I. General information

NPI: 1679147805
Provider Name (Legal Business Name): CHAPPELL COUNSELING GROUP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/13/2021
Last Update Date: 03/28/2026
Certification Date: 03/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1133 LOUISIANA AVE STE 209
WINTER PARK FL
32789-2350
US

IV. Provider business mailing address

1133 LOUISIANA AVE STE 209
WINTER PARK FL
32789-2350
US

V. Phone/Fax

Practice location:
  • Phone: 407-547-6169
  • Fax:
Mailing address:
  • Phone: 407-676-4645
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DERICK CHAPPELL
Title or Position: OWNER
Credential: LMHC
Phone: 407-547-6169