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General NPI Number Information
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NPI Number | 1275356909
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Entity Type | Organization
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Legal Business Name | INSIGHT LICENSED PROFESSIONAL CLINICAL COUNSELOR AND FAMILY THERAPY
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Dates
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Enumeration Date | 11/01/2024
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Last Update Date | 11/01/2024
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Provider Practice Location Address
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Address Line | 1835 PORTOLA DR
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City | SANTA CRUZ
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State | CA
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Zip | 95062-4918
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Country | US
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Telephone | 831-222-0455
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Fax |
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Provider Business Mailing Address
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Address Line | 1146 SOQUEL AVE UNIT 4071
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City | SANTA CRUZ
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State | CA
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Zip | 95063-1085
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Country | US
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Telephone | 831-222-0455
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MACY CHAPMAN
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Credential | LMFT, LPCC
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Telephone | 831-222-0455
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number |
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License Number State |
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