Provider Demographics
NPI:1467294702
Name:CHAPPELL, PORNSAWAN (PLPC)
Entity type:Individual
Prefix:
First Name:PORNSAWAN
Middle Name:
Last Name:CHAPPELL
Suffix:
Gender:F
Credentials:PLPC
Other - Prefix:
Other - First Name:JEN
Other - Middle Name:
Other - Last Name:CHAPPELL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PLPC
Mailing Address - Street 1:105 MEADOW OAKS LN
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39209-2001
Mailing Address - Country:US
Mailing Address - Phone:601-415-1822
Mailing Address - Fax:
Practice Address - Street 1:700 AVIGNON DR
Practice Address - Street 2:
Practice Address - City:RIDGELAND
Practice Address - State:MS
Practice Address - Zip Code:39157-5159
Practice Address - Country:US
Practice Address - Phone:662-532-6080
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-08
Last Update Date:2024-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS1086101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional