Provider Demographics
NPI:1003787565
Name:CHANCELLOR, GERAD
Entity type:Individual
Prefix:
First Name:GERAD
Middle Name:
Last Name:CHANCELLOR
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1205 SENECA PL
Mailing Address - Street 2:
Mailing Address - City:GLENN HEIGHTS
Mailing Address - State:TX
Mailing Address - Zip Code:75154-8821
Mailing Address - Country:US
Mailing Address - Phone:469-337-3711
Mailing Address - Fax:
Practice Address - Street 1:1205 SENECA PL
Practice Address - Street 2:
Practice Address - City:GLENN HEIGHTS
Practice Address - State:TX
Practice Address - Zip Code:75154-8821
Practice Address - Country:US
Practice Address - Phone:469-337-3711
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-09-16
Last Update Date:2025-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX251T00000X, 320700000X, 172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker
No251T00000XAgenciesProgram of All-Inclusive Care for the Elderly (PACE) Provider Organization
No320700000XResidential Treatment FacilitiesResidential Treatment Facility, Physical Disabilities