Provider Demographics
NPI:1689698722
Name:CHAPMAN, CYNTHIA C (PHD)
Entity Type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:C
Last Name:CHAPMAN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:RR 1 BOX 67
Mailing Address - Street 2:
Mailing Address - City:HARLEM
Mailing Address - State:MT
Mailing Address - Zip Code:59526-9705
Mailing Address - Country:US
Mailing Address - Phone:406-353-3163
Mailing Address - Fax:406-353-3308
Practice Address - Street 1:RR 1 BOX 67
Practice Address - Street 2:
Practice Address - City:HARLEM
Practice Address - State:MT
Practice Address - Zip Code:59526-9705
Practice Address - Country:US
Practice Address - Phone:406-353-3163
Practice Address - Fax:406-353-3308
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2009-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH4791103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH4791OtherLICENSE