Provider Demographics
NPI:1558647891
Name:CHANDLER, JONATHAN NICHOLAS (PSYD, MP)
Entity Type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:NICHOLAS
Last Name:CHANDLER
Suffix:
Gender:M
Credentials:PSYD, MP
Other - Prefix:DR
Other - First Name:JON
Other - Middle Name:
Other - Last Name:CHANDLER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:5208 MAGAZINE ST
Mailing Address - Street 2:STE 138
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70115-1846
Mailing Address - Country:US
Mailing Address - Phone:504-708-4933
Mailing Address - Fax:833-708-4933
Practice Address - Street 1:1615 POYDRAS ST
Practice Address - Street 2:STE 900
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70112-1282
Practice Address - Country:US
Practice Address - Phone:504-708-4933
Practice Address - Fax:833-708-4933
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-01
Last Update Date:2019-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMP.000042103TP0016X, 103TP0016X
LA1279103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TP0016XBehavioral Health & Social Service ProvidersPsychologistPrescribing (Medical)
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2394479Medicaid
LA1558647891Medicaid