Healthcare Provider Details

I. General information

NPI: 1396658043
Provider Name (Legal Business Name): ROBERT MICHAEL CHANDLER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/24/2026
Last Update Date: 09/24/2026
Certification Date: 09/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

841 CENTRAL AVE N STE 212
KENT WA
98032-2014
US

IV. Provider business mailing address

841 CENTRAL AVE N STE 212
KENT WA
98032-2014
US

V. Phone/Fax

Practice location:
  • Phone: 206-380-3715
  • Fax:
Mailing address:
  • Phone: 206-380-3715
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCDPT.CO.70125734
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: