Healthcare Provider Details

I. General information

NPI: 1780772772
Provider Name (Legal Business Name): ELIZABETH LANE CHANDLER M.S., Q.M.H.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/11/2006
Last Update Date: 08/20/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

622 S 57TH PL
SPRINGFIELD OR
97478-5487
US

IV. Provider business mailing address

2411 MARTIN LUTHER KING BLVD LANE COUNTY BEHAVIORAL HEALTH SERVICES
EUGENE OR
97401
US

V. Phone/Fax

Practice location:
  • Phone: 541-726-8076
  • Fax:
Mailing address:
  • Phone: 541-484-1456
  • Fax: 541-682-3276

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:
Title or Position:
Credential:
Phone: