Provider Demographics
NPI:1275728354
Name:CHANCELLOR, SHEMILA S (LCSW)
Entity Type:Individual
Prefix:
First Name:SHEMILA
Middle Name:S
Last Name:CHANCELLOR
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 242
Mailing Address - Street 2:
Mailing Address - City:COLLEYVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:76034-0242
Mailing Address - Country:US
Mailing Address - Phone:817-888-8131
Mailing Address - Fax:817-928-1666
Practice Address - Street 1:805 FM 1187 E STE B
Practice Address - Street 2:
Practice Address - City:CROWLEY
Practice Address - State:TX
Practice Address - Zip Code:76036-4300
Practice Address - Country:US
Practice Address - Phone:817-888-8131
Practice Address - Fax:817-928-1666
Is Sole Proprietor?:No
Enumeration Date:2007-09-11
Last Update Date:2024-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA181601041C0700X
TX40288101YM0800X, 1041C0700X
101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health