Provider Demographics
NPI:1801090725
Name:CHAPMAN, KELLIE M (LMHC)
Entity type:Individual
Prefix:MRS
First Name:KELLIE
Middle Name:M
Last Name:CHAPMAN
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:605 SW PARK ST STE 203
Mailing Address - Street 2:
Mailing Address - City:OKEECHOBEE
Mailing Address - State:FL
Mailing Address - Zip Code:34972-4173
Mailing Address - Country:US
Mailing Address - Phone:863-634-7226
Mailing Address - Fax:
Practice Address - Street 1:605 SW PARK ST STE 203
Practice Address - Street 2:
Practice Address - City:OKEECHOBEE
Practice Address - State:FL
Practice Address - Zip Code:34972-4173
Practice Address - Country:US
Practice Address - Phone:863-634-7226
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH9063101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health