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General NPI Number Information
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NPI Number | 1770895112
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Entity Type | Individual
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Provider Name | HOLLY R CHANDLER MBS, LBP
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Gender | Female
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Dates
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Enumeration Date | 07/13/2010
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Last Update Date | 07/13/2010
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Provider Practice Location Address
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Address Line | 120 S 4TH ST
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City | OKEMAH
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State | OK
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Zip | 74859-3802
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Country | US
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Telephone | 918-623-1199
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Fax | 918-623-2334
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Provider Business Mailing Address
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Address Line | PO BOX 74
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City | PADEN
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State | OK
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Zip | 74860-0074
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Country | US
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Telephone | 405-249-4361
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Fax | 918-623-2334
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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 | 0176
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License Number State | OK
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Taxonomy #2
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Taxonomy Code | 103TB0200X
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Taxonomy Name | Cognitive & Behavioral Psychologist
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License Number | 0176
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License Number State | OK
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