Provider Demographics
NPI:1346333150
Name:CHAMBLISS, AMY ELIZABETH (PSYD)
Entity Type:Individual
Prefix:DR
First Name:AMY
Middle Name:ELIZABETH
Last Name:CHAMBLISS
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:145 E PROSPECT AVE
Mailing Address - Street 2:SUITE 218
Mailing Address - City:DANVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:94526-3868
Mailing Address - Country:US
Mailing Address - Phone:925-413-2250
Mailing Address - Fax:
Practice Address - Street 1:145 E PROSPECT AVE
Practice Address - Street 2:SUITE 218
Practice Address - City:DANVILLE
Practice Address - State:CA
Practice Address - Zip Code:94526-3868
Practice Address - Country:US
Practice Address - Phone:925-413-2250
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-02
Last Update Date:2008-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY 18614103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical