Provider Demographics
NPI:1962845768
Name:MCINNIS, CHANCE MICHAEL
Entity Type:Individual
Prefix:
First Name:CHANCE
Middle Name:MICHAEL
Last Name:MCINNIS
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 1:8643 RADCLIFFE DR
Mailing Address - Street 2:
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75703-5220
Mailing Address - Country:US
Mailing Address - Phone:903-539-6077
Mailing Address - Fax:
Practice Address - Street 1:8643 RADCLIFFE DR
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75703-5220
Practice Address - Country:US
Practice Address - Phone:903-539-6077
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-04-10
Last Update Date:2018-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD.2073892084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry