Provider Demographics
NPI:1508593088
Name:CHANDLER, JACI LYNN (T-LMHC)
Entity Type:Individual
Prefix:
First Name:JACI
Middle Name:LYNN
Last Name:CHANDLER
Suffix:
Gender:F
Credentials:T-LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 N MARKET ST
Mailing Address - Street 2:
Mailing Address - City:OSKALOOSA
Mailing Address - State:IA
Mailing Address - Zip Code:52577-2827
Mailing Address - Country:US
Mailing Address - Phone:641-658-9311
Mailing Address - Fax:
Practice Address - Street 1:120 N MARKET ST
Practice Address - Street 2:
Practice Address - City:OSKALOOSA
Practice Address - State:IA
Practice Address - Zip Code:52577-2827
Practice Address - Country:US
Practice Address - Phone:641-658-9311
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-04
Last Update Date:2023-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA114836101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health