Provider Demographics
NPI:1629360219
Name:CHAPPELL, BROCKTON GREGGORY
Entity Type:Individual
Prefix:MR
First Name:BROCKTON
Middle Name:GREGGORY
Last Name:CHAPPELL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:295 N BEACON DR
Mailing Address - Street 2:
Mailing Address - City:CEDAR CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84720-3098
Mailing Address - Country:US
Mailing Address - Phone:702-375-6544
Mailing Address - Fax:
Practice Address - Street 1:295 N BEACON DR
Practice Address - Street 2:
Practice Address - City:CEDAR CITY
Practice Address - State:UT
Practice Address - Zip Code:84720-3098
Practice Address - Country:US
Practice Address - Phone:702-375-6544
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-05-14
Last Update Date:2011-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)