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General NPI Number Information
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NPI Number | 1033935572
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Entity Type | Individual
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Provider Name | KATRINA OLIVIA CHANDLER
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Gender | Female
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Dates
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Enumeration Date | 11/30/2024
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Last Update Date | 11/30/2024
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Provider Practice Location Address
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Address Line | 4515 S MCCLINTOCK DR STE 114
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City | TEMPE
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State | AZ
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Zip | 85282-7381
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Country | US
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Telephone | 480-530-7581
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Fax |
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Provider Business Mailing Address
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Address Line | 4690 S LAKESHORE DR APT 2031
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City | TEMPE
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State | AZ
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Zip | 85282-1148
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Country | US
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Telephone | 480-809-1513
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 000000000000
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License Number State | AZ
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