Doctor Name: | MR. PETER JONAS CHANDLER |
NPI Number: | 1063693679 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | LLPC |
License Number: | 6401008669 |
Business Practice Address: | 173 E Apple Ave Muskegon, MI - 494423463 |
Business Phone Number: | 2317246050 |
Business Fax Number: | 2317246066 |
Mailing Address: | 376 E Apple Ave, MUSKEGON |
State: | MI |
Postal Code: | 494423466 |
Phone Number: | 2317246050 |
Fax Number: | 2317246066 |
NPI Enumeration Date: | 11/26/2007 |
NPI Last Update Date: | 11/26/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YP2500X |
License Number: | 6401008669 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MI |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Professional |
Taxonomy Definition: |