Provider Demographics
NPI:1104475821
Name:CHANCELLOR PROFESSIONAL COUNSELING SERVICES PLLC
Entity type:Organization
Organization Name:CHANCELLOR PROFESSIONAL COUNSELING SERVICES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANNA
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:CHANCELLOR
Authorized Official - Suffix:
Authorized Official - Credentials:LPC-S
Authorized Official - Phone:936-933-4392
Mailing Address - Street 1:HERITAGE OFFICE SUITES
Mailing Address - Street 2:1000 HERITAGE CENTER
Mailing Address - City:ROUND ROCK
Mailing Address - State:TX
Mailing Address - Zip Code:78664
Mailing Address - Country:US
Mailing Address - Phone:936-933-4392
Mailing Address - Fax:
Practice Address - Street 1:HERITAGE OFFICE SUITES
Practice Address - Street 2:1000 HERITAGE CENTER
Practice Address - City:ROUND ROCK
Practice Address - State:TX
Practice Address - Zip Code:78664-7866
Practice Address - Country:US
Practice Address - Phone:936-933-4392
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-05
Last Update Date:2019-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty