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General NPI Number Information
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NPI Number | 1003447657
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Entity Type | Organization
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Legal Business Name | CHANDLER MENTAL HEALTH
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Dates
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Enumeration Date | 02/03/2020
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Last Update Date | 02/15/2023
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Provider Practice Location Address
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Address Line | 1900 DUNBARTON DR STE J
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City | JACKSON
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State | MS
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Zip | 39216-5015
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Country | US
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Telephone | 769-428-1681
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Fax | 769-241-5091
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Provider Business Mailing Address
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Address Line | 1900 DUNBARTON DR STE J
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City | JACKSON
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State | MS
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Zip | 39216-5015
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Country | US
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Telephone | 769-428-1681
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | DR. TL CHANDLER
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Credential | PHD, LPC
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Telephone | 769-428-1681
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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