Healthcare Provider Details

I. General information

NPI: 1699551325
Provider Name (Legal Business Name): CHANEL WEATHERS LMHC, LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/07/2023
Last Update Date: 07/20/2026
Certification Date: 07/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

142 OVERLOOK ST
MOUNT VERNON NY
10552-3352
US

IV. Provider business mailing address

142 OVERLOOK ST
MOUNT VERNON NY
10552-3352
US

V. Phone/Fax

Practice location:
  • Phone: 718-404-2396
  • Fax:
Mailing address:
  • Phone: 718-404-2396
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLPC01740
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number016362
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: