MEDICARE: MRS. JENNIFER CHAPPLE URBACH LCSW

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	1041C0700X	Clinical Social Worker	35070	TX

General Provider Information

NPI Number	:	1720272214
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JENNIFER CHAPPLE URBACH LCSW

Provider Business Mailing Address
First Line	:	2539 S GESSNER RD
Second Line	:	SUITE 24
City	:	HOUSTON
State	:	TX
Zip	:	77063-2034
Country	:	US
Telephone Number	:	713-963-0233
Fax Number	:	713-264-8638

Provider Business Practice Location Address
First Line	:	2539 S GESSNER RD
Second Line	:	SUITE 24
City	:	HOUSTON
State	:	TX
Zip	:	77063-2034
Country	:	US
Telephone Number	:	713-392-4747
Fax Number	:	713-264-8638

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

Provider Enumeration Date	:	08/28/2007
Last Update Date	:	09/23/2008

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