Provider Demographics
NPI:1255633202
Name:CHANDLER, RYAN SCOTT (MED, LCMHC, MLADC)
Entity type:Individual
Prefix:MR
First Name:RYAN
Middle Name:SCOTT
Last Name:CHANDLER
Suffix:
Gender:M
Credentials:MED, LCMHC, MLADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 MAIN ST
Mailing Address - Street 2:SUITE 143
Mailing Address - City:DOVER
Mailing Address - State:NH
Mailing Address - Zip Code:03820-3882
Mailing Address - Country:US
Mailing Address - Phone:603-343-4678
Mailing Address - Fax:603-343-5324
Practice Address - Street 1:100 MAIN ST
Practice Address - Street 2:SUITE 143
Practice Address - City:DOVER
Practice Address - State:NH
Practice Address - Zip Code:03820-3882
Practice Address - Country:US
Practice Address - Phone:603-343-4678
Practice Address - Fax:603-343-5324
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-24
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH0127101YA0400X
NH924101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH307915Medicaid