MEDICARE: MARY C CHAPMAN-DALEY MED

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101Y00000X	Counselor	LMFT0108	AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	AZ0133620	OTHER	AZ	BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1427136415
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARY C CHAPMAN-DALEY MED

Provider Business Mailing Address
First Line	:	2200 E RIVER RD STE 119
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85718-6578
Country	:	US
Telephone Number	:	520-299-0570
Fax Number	:

Provider Business Practice Location Address
First Line	:	2200 E RIVER RD STE 119
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85718-6578
Country	:	US
Telephone Number	:	520-299-0570
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/01/2006
Last Update Date	:	07/08/2007

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