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General NPI Number Information
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NPI Number | 1093304479
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Entity Type | Organization
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Legal Business Name | CHANCELLOR HOUSE, LLC
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Dates
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Enumeration Date | 01/11/2021
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Last Update Date | 01/11/2021
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Provider Practice Location Address
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Address Line | 5060 N 19TH AVE STE 214
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City | PHOENIX
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State | AZ
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Zip | 85015-3212
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Country | US
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Telephone | 480-561-7895
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Fax |
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Provider Business Mailing Address
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Address Line | 889 N COFCO CENTER CT UNIT 1151
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City | PHOENIX
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State | AZ
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Zip | 85008-6453
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Country | US
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Telephone | 480-561-7895
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Fax |
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Authorized Official
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Title or Position | CLINICAL DIRECTOR
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Name | MILISSA ANDREA WINSTON
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Credential | MHS, LASAC
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Telephone | 480-561-7895
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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License Number State |
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