Provider Demographics
NPI:1144670779
Name:CHAPMOND, THOMAS (LCDC)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:
Last Name:CHAPMOND
Suffix:
Gender:M
Credentials:LCDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1114
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:TX
Mailing Address - Zip Code:75103-7114
Mailing Address - Country:US
Mailing Address - Phone:903-574-0599
Mailing Address - Fax:
Practice Address - Street 1:343 VZ COUNTY ROAD 3122
Practice Address - Street 2:
Practice Address - City:EDGEWOOD
Practice Address - State:TX
Practice Address - Zip Code:75117-5149
Practice Address - Country:US
Practice Address - Phone:903-574-0599
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-14
Last Update Date:2016-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11958101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)