Healthcare Provider Details

I. General information

NPI: 1427544790
Provider Name (Legal Business Name): BRIAN ANDREW CHAPMAN LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2018
Last Update Date: 07/10/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5200 SW MACADAM AVE STE 580
PORTLAND OR
97239-3837
US

IV. Provider business mailing address

1344 MARILYN ST SE
SALEM OR
97302-1530
US

V. Phone/Fax

Practice location:
  • Phone: 503-231-7854
  • Fax: 503-231-8153
Mailing address:
  • Phone: 503-730-6947
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberC2247
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: