Provider Demographics
NPI:1619140860
Name:LACHAPELLE, GARY (CRADC)
Entity Type:Individual
Prefix:
First Name:GARY
Middle Name:
Last Name:LACHAPELLE
Suffix:
Gender:M
Credentials:CRADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2818 HWY 21218
Mailing Address - Street 2:
Mailing Address - City:MONTROSE
Mailing Address - State:IA
Mailing Address - Zip Code:52639
Mailing Address - Country:US
Mailing Address - Phone:319-463-5592
Mailing Address - Fax:
Practice Address - Street 1:2818 HWY 21218
Practice Address - Street 2:
Practice Address - City:MONTROSE
Practice Address - State:IA
Practice Address - Zip Code:52639
Practice Address - Country:US
Practice Address - Phone:319-463-5592
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-04-09
Last Update Date:2008-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL22570101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)