MEDICARE: MRS. RETA COZETTE CHANDLER LPC-S

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	1771	MS

General Provider Information

NPI Number	:	1265249288
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. RETA COZETTE CHANDLER LPC-S

Provider Business Mailing Address
First Line	:	505 MCLAURIN ST
Second Line	:
City	:	MADISON
State	:	MS
Zip	:	39110-8613
Country	:	US
Telephone Number	:	601-291-9521
Fax Number	:

Provider Business Practice Location Address
First Line	:	505 MCLAURIN ST
Second Line	:
City	:	MADISON
State	:	MS
Zip	:	39110-8613
Country	:	US
Telephone Number	:	601-291-9521
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/12/2024
Last Update Date	:	04/17/2026

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