Provider Demographics
NPI:1124407291
Name:CHAPMAN, LYNELLE (IMFT)
Entity Type:Individual
Prefix:
First Name:LYNELLE
Middle Name:
Last Name:CHAPMAN
Suffix:
Gender:F
Credentials:IMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16339 SILVERBIRCH RD
Mailing Address - Street 2:
Mailing Address - City:MORENO VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92551-9205
Mailing Address - Country:US
Mailing Address - Phone:951-567-9468
Mailing Address - Fax:
Practice Address - Street 1:16339 SILVERBIRCH RD
Practice Address - Street 2:
Practice Address - City:MORENOVALLEY
Practice Address - State:CA
Practice Address - Zip Code:92551
Practice Address - Country:US
Practice Address - Phone:951-567-9468
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-22
Last Update Date:2015-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAIMF61273106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist