Provider Demographics
NPI:1689744658
Name:CHAPMAN, LYA
Entity Type:Individual
Prefix:
First Name:LYA
Middle Name:
Last Name:CHAPMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:LYA
Other - Middle Name:MARIE
Other - Last Name:LITHGOW
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1330 N DUTTON AVE
Mailing Address - Street 2:STE 101
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95401-4646
Mailing Address - Country:US
Mailing Address - Phone:707-327-2811
Mailing Address - Fax:844-308-5854
Practice Address - Street 1:1330 N DUTTON AVE
Practice Address - Street 2:STE 101
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95401-4646
Practice Address - Country:US
Practice Address - Phone:707-327-2811
Practice Address - Fax:844-308-5854
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-08
Last Update Date:2016-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA27368103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical