Provider Demographics
NPI:1720452261
Name:BELL, CHASTITY (PHD, LPC)
Entity type:Individual
Prefix:
First Name:CHASTITY
Middle Name:
Last Name:BELL
Suffix:
Gender:F
Credentials:PHD, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10711 LAUREL CRK
Mailing Address - Street 2:
Mailing Address - City:CONVERSE
Mailing Address - State:TX
Mailing Address - Zip Code:78109-2442
Mailing Address - Country:US
Mailing Address - Phone:407-404-3212
Mailing Address - Fax:
Practice Address - Street 1:900 NE LOOP 410
Practice Address - Street 2:SUITE D-101
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78209-1410
Practice Address - Country:US
Practice Address - Phone:210-255-2839
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-11-20
Last Update Date:2015-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX73186101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health