Individual
KESHAWN CHANCELLOR
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
QMHS HS
Contact information
Practice address
2712 TANGY CT, DAYTON, OH 45414-3043
(937) 988-3196
Mailing address
11 W MONUMENT AVE FL 7, DAYTON, OH 45402-1274
(937) 461-4300
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0301947
—
OH
05
—
1326012360
—
OH
Enumeration date
03/25/2022
Last updated
03/25/2022
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