Provider Demographics
NPI:1033218540
Name:CHAMBERS, MARK J (PHD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:J
Last Name:CHAMBERS
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:8275 S EASTERN AVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89123-2591
Mailing Address - Country:US
Mailing Address - Phone:702-614-4550
Mailing Address - Fax:702-938-1042
Practice Address - Street 1:8275 S EASTERN AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89123-2591
Practice Address - Country:US
Practice Address - Phone:702-614-4550
Practice Address - Fax:702-938-1042
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-21
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVPY267103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV32778Medicare PIN
NVR09737Medicare UPIN