Provider Demographics
NPI:1578587374
Name:CHAMBERS, M. LYNN (PHD)
Entity Type:Individual
Prefix:DR
First Name:M.
Middle Name:LYNN
Last Name:CHAMBERS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:M.
Other - Middle Name:LYNN
Other - Last Name:CHAMBERS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:3918 S ORTONVILLE RD
Mailing Address - Street 2:SUITE E
Mailing Address - City:CLARKSTON
Mailing Address - State:MI
Mailing Address - Zip Code:48348-1256
Mailing Address - Country:US
Mailing Address - Phone:248-620-9623
Mailing Address - Fax:248-922-2304
Practice Address - Street 1:3918 S ORTONVILLE RD
Practice Address - Street 2:SUITE E
Practice Address - City:CLARKSTON
Practice Address - State:MI
Practice Address - Zip Code:48348-1256
Practice Address - Country:US
Practice Address - Phone:248-620-9623
Practice Address - Fax:248-922-2304
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301006051103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical