Healthcare Provider Details

I. General information

NPI: 1023581089
Provider Name (Legal Business Name): MR. CHANDLER REID SINCLAIR
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/02/2019
Last Update Date: 01/02/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5910 N CENTRAL EXPY STE 1820
DALLAS TX
75206-0946
US

IV. Provider business mailing address

5910 N CENTRAL EXPY STE 1820
DALLAS TX
75206-0946
US

V. Phone/Fax

Practice location:
  • Phone: 214-363-2345
  • Fax:
Mailing address:
  • Phone: 214-363-2345
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number67422
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: