Provider Demographics
NPI:1417097866
Name:CHAMBERLAIN, DAVID (LSPE)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:
Last Name:CHAMBERLAIN
Suffix:
Gender:M
Credentials:LSPE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:249 TWIN BARNS RD
Mailing Address - Street 2:
Mailing Address - City:GREENEVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37743-0968
Mailing Address - Country:US
Mailing Address - Phone:423-329-7175
Mailing Address - Fax:423-693-7607
Practice Address - Street 1:249 TWIN BARNS RD
Practice Address - Street 2:
Practice Address - City:GREENEVILLE
Practice Address - State:TN
Practice Address - Zip Code:37743-0968
Practice Address - Country:US
Practice Address - Phone:423-329-7175
Practice Address - Fax:423-693-7607
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-07
Last Update Date:2007-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000001775103TB0200X, 103TM1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TM1800XBehavioral Health & Social Service ProvidersPsychologistIntellectual & Developmental Disabilities
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral