Healthcare Provider Details

I. General information

NPI: 1144201229
Provider Name (Legal Business Name): ELIZABETH T CHANDLER LPCC
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 11/07/2005
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2600 MARBLE NE
ALBUQUERQUE NM
87131-0001
US

IV. Provider business mailing address

3939 RIO GRANDE BLVD NW
ALBUQUERQUE NM
87107-3152
US

V. Phone/Fax

Practice location:
  • Phone: 505-272-9271
  • Fax:
Mailing address:
  • Phone: 505-345-1478
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number712
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: