Healthcare Provider Details

I. General information

NPI: 1891606034
Provider Name (Legal Business Name): CHELBY CHANDLER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/16/2026
Last Update Date: 09/16/2026
Certification Date: 09/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 14TH AVE SE STE A
PUYALLUP WA
98372-3718
US

IV. Provider business mailing address

120 14TH AVE SE STE A
PUYALLUP WA
98372-3718
US

V. Phone/Fax

Practice location:
  • Phone: 206-552-0882
  • Fax:
Mailing address:
  • Phone: 206-552-0882
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: