Basic Information
| Provider Information | |||||||||
| NPI: | 1154576924 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CHAPPELL | ||||||||
| FirstName: | CHRISTOPHER | ||||||||
| MiddleName: | BLAKE | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | M.A., L.M.H.C. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2960 RODEO PARK DR W | ||||||||
| Address2: | SANTA FE COMMUNITY GUIDANCE CENTER | ||||||||
| City: | SANTA FE | ||||||||
| State: | NM | ||||||||
| PostalCode: | 875056351 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5059869633 | ||||||||
| FaxNumber: | 5058201209 | ||||||||
| Practice Location | |||||||||
| Address1: | 2960 RODEO PARK DR W | ||||||||
| Address2: | SANTA FE COMMUNITY GUIDANCE CENTER | ||||||||
| City: | SANTA FE | ||||||||
| State: | NM | ||||||||
| PostalCode: | 875056351 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5059869633 | ||||||||
| FaxNumber: | 5058201209 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/20/2008 | ||||||||
| LastUpdateDate: | 12/31/2012 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | 0135661 | NM | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.