Provider Demographics
NPI:1902339864
Name:CHANCEY, CHRISTINA L
Entity Type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:L
Last Name:CHANCEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 N 13TH ST
Mailing Address - Street 2:PO BOX 938
Mailing Address - City:MURPHYSBORO
Mailing Address - State:IL
Mailing Address - Zip Code:62966-2057
Mailing Address - Country:US
Mailing Address - Phone:618-687-2378
Mailing Address - Fax:618-687-2733
Practice Address - Street 1:20 N 13TH ST
Practice Address - Street 2:
Practice Address - City:MURPHYSBORO
Practice Address - State:IL
Practice Address - Zip Code:62966-2057
Practice Address - Country:US
Practice Address - Phone:618-687-2378
Practice Address - Fax:618-687-2733
Is Sole Proprietor?:No
Enumeration Date:2017-04-07
Last Update Date:2017-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst