Provider Demographics
NPI:1225543507
Name:CHAMBLISS, AMANI (LMFT)
Entity Type:Individual
Prefix:
First Name:AMANI
Middle Name:
Last Name:CHAMBLISS
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:AMANI
Other - Middle Name:
Other - Last Name:WILLIAMS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 7088
Mailing Address - Street 2:
Mailing Address - City:WOODLAND HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91365-7088
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:21201 KITTRIDGE ST APT 3206
Practice Address - Street 2:
Practice Address - City:WOODLAND HILLS
Practice Address - State:CA
Practice Address - Zip Code:91303-5012
Practice Address - Country:US
Practice Address - Phone:818-564-6382
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-07
Last Update Date:2022-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA125270106H00000X, 106H00000X
CA103412106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA7283Medicaid