Provider Demographics
NPI:1447275334
Name:CHIDLEY, MARK A (LMHC, CAP)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:A
Last Name:CHIDLEY
Suffix:
Gender:M
Credentials:LMHC, CAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:229 SW 35TH ST
Mailing Address - Street 2:
Mailing Address - City:CAPE CORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33914-7826
Mailing Address - Country:US
Mailing Address - Phone:239-334-4008
Mailing Address - Fax:
Practice Address - Street 1:2466 1ST ST
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33901-2940
Practice Address - Country:US
Practice Address - Phone:239-334-4008
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH4036101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health