Provider Demographics
NPI:1083240550
Name:CHANDLER, JASON EDWARD (MS, LPCC-S, LICDC)
Entity Type:Individual
Prefix:MR
First Name:JASON
Middle Name:EDWARD
Last Name:CHANDLER
Suffix:
Gender:M
Credentials:MS, LPCC-S, LICDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:422 W LOVELAND AVE
Mailing Address - Street 2:
Mailing Address - City:LOVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:45140-2322
Mailing Address - Country:US
Mailing Address - Phone:513-334-7272
Mailing Address - Fax:513-676-0051
Practice Address - Street 1:422 W LOVELAND AVE
Practice Address - Street 2:
Practice Address - City:LOVELAND
Practice Address - State:OH
Practice Address - Zip Code:45140-2322
Practice Address - Country:US
Practice Address - Phone:513-334-7272
Practice Address - Fax:513-676-0051
Is Sole Proprietor?:No
Enumeration Date:2020-03-17
Last Update Date:2024-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHLICDC.162169101YA0400X
IN39004679A101YM0800X
OHE.2202902-SUPV101YP2500X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
CS2223800174OtherCARESOURCE PROVIDER NUMBER
6185268OtherAETNA PROVIDER NUMBER
OH0479064Medicaid
IN300084117Medicaid