Provider Demographics
NPI:1003447657
Name:CHANDLER MENTAL HEALTH
Entity Type:Organization
Organization Name:CHANDLER MENTAL HEALTH
Other - Org Name:CHANDLER & ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:TL
Authorized Official - Middle Name:
Authorized Official - Last Name:CHANDLER
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, LPC
Authorized Official - Phone:769-428-1681
Mailing Address - Street 1:1900 DUNBARTON DR STE J
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39216-5015
Mailing Address - Country:US
Mailing Address - Phone:769-428-1681
Mailing Address - Fax:
Practice Address - Street 1:1900 DUNBARTON DR STE J
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39216-5015
Practice Address - Country:US
Practice Address - Phone:769-428-1681
Practice Address - Fax:769-241-5091
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CHANDLER MENTAL HEALTH
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-02-03
Last Update Date:2023-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS06305302Medicaid