Healthcare Provider Details

I. General information

NPI: 1457518938
Provider Name (Legal Business Name): MARY ANN CHANDLER LPC, LCPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/21/2008
Last Update Date: 11/08/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1016 7TH AVE S
GREAT FALLS MT
59405-2245
US

IV. Provider business mailing address

1016 7TH AVE S
GREAT FALLS MT
59405-2245
US

V. Phone/Fax

Practice location:
  • Phone: 406-579-5020
  • Fax:
Mailing address:
  • Phone: 406-579-5020
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number3699
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number1032
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: