Provider Demographics
NPI:1437796349
Name:CHANDLER, KARLISSA KAY
Entity Type:Individual
Prefix:
First Name:KARLISSA
Middle Name:KAY
Last Name:CHANDLER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1402 VILLAGE DR
Mailing Address - Street 2:
Mailing Address - City:VICTORIA
Mailing Address - State:TX
Mailing Address - Zip Code:77901-4156
Mailing Address - Country:US
Mailing Address - Phone:361-894-8734
Mailing Address - Fax:
Practice Address - Street 1:1402 VILLAGE DR STE A
Practice Address - Street 2:
Practice Address - City:VICTORIA
Practice Address - State:TX
Practice Address - Zip Code:77901-4157
Practice Address - Country:US
Practice Address - Phone:361-894-8734
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-10
Last Update Date:2019-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty