MEDICARE: L. NICHELLE CHANDLER PHD

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	101YA0400X	Addiction (Substance Use Disorder) Counselor	9854	TX
2	101YM0800X	Mental Health Counselor	19309	TX
3	101YP2500X	Professional Counselor	19309	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1912064106
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	L. NICHELLE CHANDLER PHD

Provider Business Mailing Address
First Line	:	PO BOX 794861
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75379-4861
Country	:	US
Telephone Number	:	469-589-1727
Fax Number	:

Provider Business Practice Location Address
First Line	:	3827 S BUCKNER BLVD
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75227-4312
Country	:	US
Telephone Number	:	214-489-9300
Fax Number	:	214-489-9301

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

Provider Enumeration Date	:	01/03/2007
Last Update Date	:	01/16/2024

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