Provider Demographics
NPI:1114105475
Name:CHADWICK, CLARISSE MARIE (LPC)
Entity Type:Individual
Prefix:
First Name:CLARISSE
Middle Name:MARIE
Last Name:CHADWICK
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:CLARE
Other - Middle Name:MARIE
Other - Last Name:CHADWICK
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPC
Mailing Address - Street 1:71 N 490 W
Mailing Address - Street 2:
Mailing Address - City:AMERICAN FORK
Mailing Address - State:UT
Mailing Address - Zip Code:84003-2264
Mailing Address - Country:US
Mailing Address - Phone:801-763-7775
Mailing Address - Fax:
Practice Address - Street 1:71 N 490 W
Practice Address - Street 2:
Practice Address - City:AMERICAN FORK
Practice Address - State:UT
Practice Address - Zip Code:84003-2264
Practice Address - Country:US
Practice Address - Phone:801-763-7775
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-02-08
Last Update Date:2008-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5142103-6004101Y00000X, 101YA0400X, 101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional