Provider Demographics
NPI:1780257048
Name:CHAPMAN, TABITHA (MFT)
Entity type:Individual
Prefix:
First Name:TABITHA
Middle Name:
Last Name:CHAPMAN
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24875 PRIELIPP RD APT 711
Mailing Address - Street 2:
Mailing Address - City:WILDOMAR
Mailing Address - State:CA
Mailing Address - Zip Code:92595-7797
Mailing Address - Country:US
Mailing Address - Phone:951-249-0924
Mailing Address - Fax:
Practice Address - Street 1:6235 RIVER CREST DR STE J
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92507-0758
Practice Address - Country:US
Practice Address - Phone:951-249-0924
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-22
Last Update Date:2021-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist