Healthcare Provider Details

I. General information

NPI: 1003447657
Provider Name (Legal Business Name): CHANDLER MENTAL HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/03/2020
Last Update Date: 02/15/2023
Certification Date: 02/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1900 DUNBARTON DR STE J
JACKSON MS
39216-5015
US

IV. Provider business mailing address

1900 DUNBARTON DR STE J
JACKSON MS
39216-5015
US

V. Phone/Fax

Practice location:
  • Phone: 769-428-1681
  • Fax: 769-241-5091
Mailing address:
  • Phone: 769-428-1681
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: DR. TL CHANDLER
Title or Position: CEO
Credential: PHD, LPC
Phone: 769-428-1681