Active NPI
Gavic Jaacob Chandler, M.A.
- Mental Health Counselor
- Clarksville, TN
National Provider Identifier
1366570749
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- License
- RC00029571
- Practice address
- 810 Greenwood Ave
Clarksville, TN 37040-4068 - Phone
- (931) 206-7257
- Fax
- (931) 260-7332
- NPI assigned
- Feb 28, 2007
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | RC00029571 | WA | Primary |
Addresses
Primary practice location
810 Greenwood Ave
Clarksville, TN 37040-4068
Mailing address
PO Box 6
Clarksville, TN 37041-0006
Phone (931) 206-7356
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Master of Arts
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| RC00029571 | WA | MD | Mental Health Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1172620800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1366570749",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 6",
"city": "CLARKSVILLE",
"state": "TN",
"postal_code": "370410006",
"telephone_number": "931-206-7356",
"fax_number": "931-260-7332"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "810 GREENWOOD AVE",
"city": "CLARKSVILLE",
"state": "TN",
"postal_code": "370404068",
"telephone_number": "931-206-7257",
"fax_number": "931-260-7332"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CHANDLER",
"first_name": "GAVIC",
"middle_name": "JAACOB",
"name_prefix": "Mr.",
"credential": "M.A.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-02-28",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "WA",
"license": "RC00029571",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Clarksville, TN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.