Provider Demographics
NPI:1720486632
Name:CHAPA, ELIAS JR (EDS)
Entity Type:Individual
Prefix:
First Name:ELIAS
Middle Name:
Last Name:CHAPA
Suffix:JR
Gender:M
Credentials:EDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:880 GREENWOOD LN
Mailing Address - Street 2:
Mailing Address - City:TRENTON
Mailing Address - State:OH
Mailing Address - Zip Code:45067-1076
Mailing Address - Country:US
Mailing Address - Phone:513-465-1296
Mailing Address - Fax:
Practice Address - Street 1:880 GREENWOOD LN
Practice Address - Street 2:
Practice Address - City:TRENTON
Practice Address - State:OH
Practice Address - Zip Code:45067-1076
Practice Address - Country:US
Practice Address - Phone:513-465-1296
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-12-09
Last Update Date:2014-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool