Provider Demographics
NPI:1497124622
Name:CHANDLER, CHRISTOPHER G
Entity Type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:G
Last Name:CHANDLER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:104 REYNOLDS RD
Mailing Address - Street 2:
Mailing Address - City:GLASGOW
Mailing Address - State:KY
Mailing Address - Zip Code:42141-1177
Mailing Address - Country:US
Mailing Address - Phone:270-678-4801
Mailing Address - Fax:270-678-3866
Practice Address - Street 1:1910 LYDA AVE
Practice Address - Street 2:
Practice Address - City:BOWLING GREEN
Practice Address - State:KY
Practice Address - Zip Code:42104-3326
Practice Address - Country:US
Practice Address - Phone:270-904-6567
Practice Address - Fax:270-904-6570
Is Sole Proprietor?:No
Enumeration Date:2015-09-17
Last Update Date:2019-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY247368103TB0200X, 103TC0700X, 103TC2200X, 103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent