Provider Demographics
NPI:1477607315
Name:CHANDLER, GUY RUSSELL (DPHIL)
Entity Type:Individual
Prefix:DR
First Name:GUY
Middle Name:RUSSELL
Last Name:CHANDLER
Suffix:
Gender:M
Credentials:DPHIL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17103 PRESTON RD
Mailing Address - Street 2:SUITE 288
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75248-1332
Mailing Address - Country:US
Mailing Address - Phone:972-250-0498
Mailing Address - Fax:972-250-0943
Practice Address - Street 1:17103 PRESTON RD
Practice Address - Street 2:SUITE 288
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75248-1332
Practice Address - Country:US
Practice Address - Phone:972-250-0498
Practice Address - Fax:972-250-0943
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-22
Last Update Date:2007-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11401101YP2500X
TX3707106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist