Healthcare Provider Details

I. General information

NPI: 1063841997
Provider Name (Legal Business Name): MADIGAN CHANDLER LPCC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/01/2013
Last Update Date: 03/15/2021
Certification Date: 03/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2074 GALISTEO ST STE B4
SANTA FE NM
87505-2157
US

IV. Provider business mailing address

1437 SANTA CRUZ DR
SANTA FE NM
87505-3865
US

V. Phone/Fax

Practice location:
  • Phone: 505-362-2934
  • Fax:
Mailing address:
  • Phone: 505-362-2934
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberT-0161171
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number0185571
License Number StateNM
# 3
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberCCMH0185571
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: