Provider Demographics
NPI:1912064106
Name:CHANDLER, L. NICHELLE (PHD)
Entity Type:Individual
Prefix:
First Name:L.
Middle Name:NICHELLE
Last Name:CHANDLER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 794861
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75379-4861
Mailing Address - Country:US
Mailing Address - Phone:469-589-1727
Mailing Address - Fax:
Practice Address - Street 1:3827 S BUCKNER BLVD
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75227-4312
Practice Address - Country:US
Practice Address - Phone:214-489-9300
Practice Address - Fax:214-489-9301
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-03
Last Update Date:2024-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX9854101YA0400X
TX19309101YM0800X, 101YP2500X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX188666501Medicaid