Provider Demographics
NPI:1457518938
Name:CHANDLER, MARY ANN (LPC, LCPC)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:ANN
Last Name:CHANDLER
Suffix:
Gender:F
Credentials:LPC, LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1016 7TH AVE S
Mailing Address - Street 2:
Mailing Address - City:GREAT FALLS
Mailing Address - State:MT
Mailing Address - Zip Code:59405-2245
Mailing Address - Country:US
Mailing Address - Phone:406-579-5020
Mailing Address - Fax:
Practice Address - Street 1:1016 7TH AVE S
Practice Address - Street 2:
Practice Address - City:GREAT FALLS
Practice Address - State:MT
Practice Address - Zip Code:59405-2245
Practice Address - Country:US
Practice Address - Phone:406-579-5020
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-21
Last Update Date:2012-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT1032174400000X
CO3699101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional