Provider Demographics
NPI:1437624525
Name:KNOWLES, CHESLEY RAMBIN (LPA W/INDPRACTICE)
Entity Type:Individual
Prefix:MRS
First Name:CHESLEY
Middle Name:RAMBIN
Last Name:KNOWLES
Suffix:
Gender:F
Credentials:LPA W/INDPRACTICE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 9803
Mailing Address - Street 2:
Mailing Address - City:LONGVIEW
Mailing Address - State:TX
Mailing Address - Zip Code:75608-9803
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1101 YATES DR
Practice Address - Street 2:
Practice Address - City:LONGVIEW
Practice Address - State:TX
Practice Address - Zip Code:75601-4666
Practice Address - Country:US
Practice Address - Phone:903-738-5587
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-04
Last Update Date:2018-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX31231103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX31231OtherTEXAS STATE BOARD OF EXAMINERS OF PSYCHOLOGISTS