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General NPI Number Information
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NPI Number | 1821774217
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Entity Type | Individual
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Provider Name | CHANCEY FORT LPC, RPT, NCC, NCSC
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Gender | Female
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Dates
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Enumeration Date | 06/22/2023
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Last Update Date | 10/01/2025
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Provider Practice Location Address
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Address Line | 105 EXECUTIVE DR STE A
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City | MADISON
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State | MS
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Zip | 39110-8496
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Country | US
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Telephone | 601-340-9498
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Fax | 601-287-6647
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Provider Business Mailing Address
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Address Line | 272 CALHOUN STATION PKWY STE C
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City | GLUCKSTADT
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State | MS
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Zip | 39110-5541
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Country | US
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Telephone | 662-739-3505
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 2996
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License Number State | MS
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 2996
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License Number State | MS
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