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NPI Code Detail

MEDICARE: KORI CHANCELLOR M.A.

MEDICARE: KORI CHANCELLOR M.A.
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
1101YM0800XMental Health Counselor

General Provider Information

NPI Number : 1114453982
Entity Type Code : Individual
Provider Name (Legal Business Name) : KORI CHANCELLOR M.A.
Provider Business Mailing Address
First Line : PO BOX 936
Second Line :
City : DALLAS
State : OR
Zip : 97338-0936
Country : US
Telephone Number : 971-301-2819
Fax Number :
Provider Business Practice Location Address
First Line : 355 MILLER ST SE
Second Line :
City : SALEM
State : OR
Zip : 97302-4247
Country : US
Telephone Number : 971-301-2819
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/11/2017
Last Update Date : 05/11/2017

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Directions to “ KORI CHANCELLOR M.A.” Practice Location

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