Provider Demographics
NPI:1053694653
Name:ANDERSON, CHANDRA LIZETTE (LPC, MT-BC)
Entity type:Individual
Prefix:
First Name:CHANDRA
Middle Name:LIZETTE
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:LPC, MT-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1923 LANARK AVE
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75203-4522
Mailing Address - Country:US
Mailing Address - Phone:214-942-3924
Mailing Address - Fax:
Practice Address - Street 1:1923 LANARK AVE
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75203-4522
Practice Address - Country:US
Practice Address - Phone:214-942-3924
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-21
Last Update Date:2011-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX17878101YP2500X
TX04022225A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No225A00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMusic Therapist