Provider Demographics
NPI:1790195998
Name:CHAPLA, BROOKE ALISSA (PSY)
Entity Type:Individual
Prefix:
First Name:BROOKE
Middle Name:ALISSA
Last Name:CHAPLA
Suffix:
Gender:F
Credentials:PSY
Other - Prefix:
Other - First Name:BROOKE
Other - Middle Name:ALISSA
Other - Last Name:WALLS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:INTERNAL MEDICINE
Mailing Address - Street 2:401 SAN MATEO BLVD SE
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87108-2921
Mailing Address - Country:US
Mailing Address - Phone:505-462-7333
Mailing Address - Fax:505-462-7440
Practice Address - Street 1:INTERNAL MEDICINE
Practice Address - Street 2:401 SAN MATEO BLVD SE
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87108-2921
Practice Address - Country:US
Practice Address - Phone:505-462-7333
Practice Address - Fax:505-462-7440
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-28
Last Update Date:2022-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE10098390200000X
NM390200000X
NM1635103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program