Provider Demographics
NPI:1497852891
Name:CHANEY, EDMUND (PHD)
Entity Type:Individual
Prefix:DR
First Name:EDMUND
Middle Name:
Last Name:CHANEY
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:86948 MCTIMMONS LN
Mailing Address - Street 2:
Mailing Address - City:BANDON
Mailing Address - State:OR
Mailing Address - Zip Code:97411-7250
Mailing Address - Country:US
Mailing Address - Phone:206-779-9286
Mailing Address - Fax:
Practice Address - Street 1:86948 MCTIMMONS LN
Practice Address - Street 2:
Practice Address - City:BANDON
Practice Address - State:OR
Practice Address - Zip Code:97411-7250
Practice Address - Country:US
Practice Address - Phone:206-779-9286
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2011-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TH0004XBehavioral Health & Social Service ProvidersPsychologistHealth