Provider Demographics
NPI:1184146938
Name:CHANDLER, TL (PHD, LPC)
Entity type:Individual
Prefix:
First Name:TL
Middle Name:
Last Name:CHANDLER
Suffix:
Gender:M
Credentials:PHD, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1900 DUNBARTON DR STE J
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39216-5015
Mailing Address - Country:US
Mailing Address - Phone:769-428-1681
Mailing Address - Fax:
Practice Address - Street 1:1900 DUNBARTON DR STE J
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39216-5015
Practice Address - Country:US
Practice Address - Phone:769-428-1681
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-13
Last Update Date:2023-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS2396101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor