Provider Demographics
NPI:1710475017
Name:CHAPPELL, AYONNA M (MA, LPC)
Entity Type:Individual
Prefix:
First Name:AYONNA
Middle Name:M
Last Name:CHAPPELL
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:AYONNA
Other - Middle Name:M
Other - Last Name:MCCULLOUGH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MA LPC
Mailing Address - Street 1:3710 E LA SALLE ST APT 3104
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80909-2622
Mailing Address - Country:US
Mailing Address - Phone:620-605-2346
Mailing Address - Fax:
Practice Address - Street 1:411 LAKEWOOD CIR STE A110J
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80910-4644
Practice Address - Country:US
Practice Address - Phone:719-418-1711
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-23
Last Update Date:2022-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
COLPC.0013779101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health