Provider Demographics
NPI:1629523121
Name:CHAPMAN, BRENDA
Entity Type:Individual
Prefix:
First Name:BRENDA
Middle Name:
Last Name:CHAPMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:BRENDA
Other - Middle Name:J
Other - Last Name:CHAPMAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPC
Mailing Address - Street 1:2601 AIRPORT FWY
Mailing Address - Street 2:SUITE 200
Mailing Address - City:FT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76111-2379
Mailing Address - Country:US
Mailing Address - Phone:817-440-3717
Mailing Address - Fax:
Practice Address - Street 1:2601 AIRPORT FWY
Practice Address - Street 2:SUITE 200
Practice Address - City:FT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76111-2379
Practice Address - Country:US
Practice Address - Phone:817-440-3717
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-24
Last Update Date:2016-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX67559101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor