Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101Y00000X | Counselor | 68873 | TX |
NPI | 1003380833 |
---|---|
Provider Name | Jeff Chandler |
First Address | Rockwall, TX 75032-8701 |
Second Address | Rockwall, TX 75032-8701 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/01/2019 |
Last Update Date | 15/01/2019 |