Healthcare Provider Details

I. General information

NPI: 1154576924
Provider Name (Legal Business Name): CHRISTOPHER BLAKE CHAPPELL M.A., L.M.H.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/20/2008
Last Update Date: 12/31/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2960 RODEO PARK DR W SANTA FE COMMUNITY GUIDANCE CENTER
SANTA FE NM
87505-6351
US

IV. Provider business mailing address

2960 RODEO PARK DR W SANTA FE COMMUNITY GUIDANCE CENTER
SANTA FE NM
87505-6351
US

V. Phone/Fax

Practice location:
  • Phone: 505-986-9633
  • Fax: 505-820-1209
Mailing address:
  • Phone: 505-986-9633
  • Fax: 505-820-1209

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number0135661
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: