Healthcare Provider Details

I. General information

NPI: 1427721190
Provider Name (Legal Business Name): GEORGE AUGUST CHAPP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/28/2021
Last Update Date: 07/28/2021
Certification Date: 07/27/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12200 E 13 MILE RD
WARREN MI
48093-3093
US

IV. Provider business mailing address

4753 STILWELL DR
WARREN MI
48092-2306
US

V. Phone/Fax

Practice location:
  • Phone: 586-573-1810
  • Fax:
Mailing address:
  • Phone: 586-596-5953
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number6362009379
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: