Provider Demographics
NPI:1225608250
Name:CHAMBERLAIN, BRIONNE PORTER (MFT INTERN)
Entity Type:Individual
Prefix:
First Name:BRIONNE
Middle Name:PORTER
Last Name:CHAMBERLAIN
Suffix:
Gender:F
Credentials:MFT INTERN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:507 W WATER GROVE DR
Mailing Address - Street 2:
Mailing Address - City:EAGLE
Mailing Address - State:ID
Mailing Address - Zip Code:83616-5747
Mailing Address - Country:US
Mailing Address - Phone:208-760-7840
Mailing Address - Fax:
Practice Address - Street 1:750 W USTICK RD STE 120
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83646-6133
Practice Address - Country:US
Practice Address - Phone:208-600-2072
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-30
Last Update Date:2021-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist