Healthcare Provider Details

I. General information

NPI: 1629637178
Provider Name (Legal Business Name): TIERRA S CHAPPEL LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/09/2019
Last Update Date: 05/20/2024
Certification Date: 12/29/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 SCOTTIE DRIVE
GLASGOW KY
42141
US

IV. Provider business mailing address

PO BOX 1080
BURKESVILLE KY
42717-1080
US

V. Phone/Fax

Practice location:
  • Phone: 844-435-0900
  • Fax: 270-858-4029
Mailing address:
  • Phone: 270-858-6655
  • Fax: 270-858-4027

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number255373
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: