MEDICARE: DR. MARY CHANDLER SELF M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084P0800X	Psychiatry Physician	268156	NY
2	2084P0800X	Psychiatry Physician	R5315	TX

General Provider Information

NPI Number	:	1053607853
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARY CHANDLER SELF M.D.

Provider Business Mailing Address
First Line	:	104 W 12TH ST STE B
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77008-6990
Country	:	US
Telephone Number	:	972-965-4232
Fax Number	:	972-347-8109

Provider Business Practice Location Address
First Line	:	104 W 12TH ST STE B
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77008-6990
Country	:	US
Telephone Number	:	972-965-4232
Fax Number	:	972-347-8109

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/21/2011
Last Update Date	:	01/20/2026

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