Provider Demographics
NPI:1831661727
Name:CHAPPELL, MARY TATUM (PHD)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:TATUM
Last Name:CHAPPELL
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 1:2 WISCONSIN CIR STE 700
Mailing Address - Street 2:
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20815-7007
Mailing Address - Country:US
Mailing Address - Phone:844-942-1789
Mailing Address - Fax:
Practice Address - Street 1:2 WISCONSIN CIR STE 700
Practice Address - Street 2:
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20815-7007
Practice Address - Country:US
Practice Address - Phone:844-942-1789
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-18
Last Update Date:2023-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCPSY1001341103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical