MEDICARE: CHAPMAN HEALTH AND WELLNESS GROUP INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	101YM0800X	Mental Health Counselor
2	103TC0700X	Clinical Psychologist
3	103TP2701X	Group Psychotherapy Psychologist

General Provider Information

NPI Number	:	1356020705
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHAPMAN HEALTH AND WELLNESS GROUP INC

Provider Business Mailing Address
First Line	:	2010 N HOLLYWOOD WAY
Second Line	:
City	:	BURBANK
State	:	CA
Zip	:	91505-1520
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2626 S RAINBOW BLVD STE 105
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89146-5190
Country	:	US
Telephone Number	:	818-433-7056
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	TISTO CHAPMAN
Credential	:
Telephone Number	:	818-321-1095

Provider Enumeration Date	:	07/13/2023
Last Update Date	:	07/13/2023

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