Healthcare Provider Details

I. General information

NPI: 1043726623
Provider Name (Legal Business Name): JASMINE RENEE CHAPPELL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/19/2017
Last Update Date: 08/19/2026
Certification Date: 08/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5955 RIDGE RD
CLEVELAND OH
44129-3936
US

IV. Provider business mailing address

1106 GOLD RUSH BLVD APT B15
CHARLOTTE NC
28262-6115
US

V. Phone/Fax

Practice location:
  • Phone: 440-888-0300
  • Fax:
Mailing address:
  • Phone: 216-385-9956
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberE.2606613
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: