Healthcare Provider Details

I. General information

NPI: 1740963982
Provider Name (Legal Business Name): MADISON CHAPMAN PHD LP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/14/2023
Last Update Date: 07/30/2025
Certification Date: 07/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

319 E BROADWAY ST
MT PLEASANT MI
48858-2647
US

IV. Provider business mailing address

319 E BROADWAY ST
MT PLEASANT MI
48858-2647
US

V. Phone/Fax

Practice location:
  • Phone: 989-613-7800
  • Fax:
Mailing address:
  • Phone: 989-613-7800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number State

VIII. Authorized Official

Name: MADISON CHAPMAN
Title or Position: OWNER/PSYCHOLOGIST
Credential: PHD LP
Phone: 231-838-5172