Provider Demographics
NPI:1053607853
Name:SELF, CHANDLER (MD)
Entity type:Individual
Prefix:DR
First Name:CHANDLER
Middle Name:
Last Name:SELF
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2929 ALLEN PKWY STE 200
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77019-7123
Mailing Address - Country:US
Mailing Address - Phone:972-965-4232
Mailing Address - Fax:972-347-8109
Practice Address - Street 1:2929 ALLEN PKWY STE 200
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77019-7123
Practice Address - Country:US
Practice Address - Phone:972-965-4232
Practice Address - Fax:972-347-8109
Is Sole Proprietor?:No
Enumeration Date:2011-06-21
Last Update Date:2024-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2681562084P0800X
TXR53152084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03859309Medicaid