Provider Demographics
NPI:1265132229
Name:MACNEIL, KATELYN CHAPPELL
Entity type:Individual
Prefix:
First Name:KATELYN
Middle Name:CHAPPELL
Last Name:MACNEIL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:109 OSIGIAN BLVD STE 400
Mailing Address - Street 2:
Mailing Address - City:WARNER ROBINS
Mailing Address - State:GA
Mailing Address - Zip Code:31088-8925
Mailing Address - Country:US
Mailing Address - Phone:478-449-1475
Mailing Address - Fax:
Practice Address - Street 1:109 OSIGIAN BLVD STE 400
Practice Address - Street 2:
Practice Address - City:WARNER ROBINS
Practice Address - State:GA
Practice Address - Zip Code:31088-8925
Practice Address - Country:US
Practice Address - Phone:478-449-1475
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-08
Last Update Date:2023-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
GAAPC008781101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty