Provider Demographics
NPI:1255009353
Name:MILLS, CHANDLER (BS, MS, RBT)
Entity Type:Individual
Prefix:
First Name:CHANDLER
Middle Name:
Last Name:MILLS
Suffix:
Gender:M
Credentials:BS, MS, RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:39 ESTATE DR
Mailing Address - Street 2:
Mailing Address - City:BROOKVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:45309-9207
Mailing Address - Country:US
Mailing Address - Phone:317-560-2223
Mailing Address - Fax:
Practice Address - Street 1:2134 HOLIDAY LN
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:IN
Practice Address - Zip Code:46131-2600
Practice Address - Country:US
Practice Address - Phone:317-474-8512
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-02
Last Update Date:2023-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
INRBT-21-173286106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician