Basic Information
| Provider Information | |||||||||
| NPI: | 1083359012 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CHANDROO | ||||||||
| FirstName: | CHRISTOPHER | ||||||||
| MiddleName: | ANTHONY | ||||||||
| NamePrefix: | MR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 222 SE 8TH AVENUE | ||||||||
| Address2: | SUITE 212 | ||||||||
| City: | HILLSBORO | ||||||||
| State: | OR | ||||||||
| PostalCode: | 97123 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 222 SE 8TH AVENUE | ||||||||
| Address2: | SUITE 212 | ||||||||
| City: | HILLSBORO | ||||||||
| State: | OR | ||||||||
| PostalCode: | 97123 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5033527333 | ||||||||
| FaxNumber: | 9712662956 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/04/2022 | ||||||||
| LastUpdateDate: | 05/04/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 05/04/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
ID Information
| ID | Type | State | Issuer | Description | 101YM0800X | 05 | OR | MEDICAID |