Provider Demographics
NPI:1386766988
Name:CHAPMAN, E. JUANITA (MFT, LADC)
Entity type:Individual
Prefix:MS
First Name:E.
Middle Name:JUANITA
Last Name:CHAPMAN
Suffix:
Gender:F
Credentials:MFT, LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11785 HEARTPINE
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89506
Mailing Address - Country:US
Mailing Address - Phone:775-412-8713
Mailing Address - Fax:
Practice Address - Street 1:65 REGENCY WAY
Practice Address - Street 2:SUITE C
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89509
Practice Address - Country:US
Practice Address - Phone:775-412-8713
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-04
Last Update Date:2009-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV00987-I101YA0400X
NVR05389106H00000X
NE1066106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV100511800Medicaid