Healthcare Provider Details

I. General information

NPI: 1982256665
Provider Name (Legal Business Name): AMY LYNN CHAPMOND
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/12/2019
Last Update Date: 07/12/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

114 JORDAN PLAZA BLVD STE 302306
TYLER TX
75704-2056
US

IV. Provider business mailing address

114 JORDAN PLAZA BLVD STE 302306
TYLER TX
75704-2056
US

V. Phone/Fax

Practice location:
  • Phone: 903-581-9472
  • Fax: 903-581-9481
Mailing address:
  • Phone: 903-581-9472
  • Fax: 903-581-9481

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number14859
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: