Provider Demographics
NPI:1922175991
Name:CHANDLER, BRIAN KAY (PSYD)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:KAY
Last Name:CHANDLER
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1736 E SUNSHINE ST
Mailing Address - Street 2:SUITE 811
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65804-1343
Mailing Address - Country:US
Mailing Address - Phone:417-882-4485
Mailing Address - Fax:417-882-5517
Practice Address - Street 1:1736 E SUNSHINE ST
Practice Address - Street 2:SUITE 811
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65804-1343
Practice Address - Country:US
Practice Address - Phone:417-882-4485
Practice Address - Fax:417-882-5517
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO01813103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical