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NPI Code Detail

MEDICARE: MR. JOVAN CHANDLER LCPC

MEDICARE:  MR. JOVAN  CHANDLER  LCPC
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
1101YP2500XProfessional Counselor180009928IL

General Provider Information

NPI Number : 1497128268
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. JOVAN CHANDLER LCPC
Provider Business Mailing Address
First Line : 4752 S SHIELDS AVE
Second Line :
City : CHICAGO
State : IL
Zip : 60609-4529
Country : US
Telephone Number : 312-731-3381
Fax Number :
Provider Business Practice Location Address
First Line : 3752 W 16TH ST
Second Line :
City : CHICAGO
State : IL
Zip : 60623-2028
Country : US
Telephone Number : 773-762-2435
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/02/2015
Last Update Date : 11/02/2015

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Directions to “ MR. JOVAN CHANDLER LCPC” Practice Location

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