Provider Demographics
NPI:1205375250
Name:GENE CHAMBERS PHD PLLC
Entity Type:Organization
Organization Name:GENE CHAMBERS PHD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GENE
Authorized Official - Middle Name:
Authorized Official - Last Name:CHAMBERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:479-313-6333
Mailing Address - Street 1:2592 N GREGG AVE
Mailing Address - Street 2:STE 16
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72703-5543
Mailing Address - Country:US
Mailing Address - Phone:479-313-6333
Mailing Address - Fax:479-313-6168
Practice Address - Street 1:2592 N GREGG AVE
Practice Address - Street 2:STE 16
Practice Address - City:FAYETTEVILLE
Practice Address - State:AR
Practice Address - Zip Code:72703-5543
Practice Address - Country:US
Practice Address - Phone:479-313-6333
Practice Address - Fax:479-313-6168
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-22
Last Update Date:2017-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103G00000XBehavioral Health & Social Service ProvidersClinical NeuropsychologistGroup - Single Specialty