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General NPI Number Information
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NPI Number | 1508674763
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Entity Type | Individual
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Provider Name | CHANDLER M PETRY ACMHC
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Gender | Female
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Dates
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Enumeration Date | 12/20/2024
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Last Update Date | 12/20/2024
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Provider Practice Location Address
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Address Line | 321 N MALL DR. VW-103
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City | ST.GEORGE
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State | UT
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Zip | 84790
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Country | US
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Telephone | 435-767-1532
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Fax |
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Provider Business Mailing Address
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Address Line | 388 E 800 S
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City | IVINS
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State | UT
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Zip | 84738-5073
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Country | US
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Telephone | 303-656-3495
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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 | 96970066009
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License Number State | UT
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