Provider Demographics
NPI:1598154791
Name:SCHAMBER, TRACY MICHEYL
Entity Type:Individual
Prefix:
First Name:TRACY
Middle Name:MICHEYL
Last Name:SCHAMBER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6166 VESPER AVE
Mailing Address - Street 2:
Mailing Address - City:VAN NUYS
Mailing Address - State:CA
Mailing Address - Zip Code:91411-2851
Mailing Address - Country:US
Mailing Address - Phone:818-997-0414
Mailing Address - Fax:818-997-0851
Practice Address - Street 1:6166 VESPER AVE
Practice Address - Street 2:
Practice Address - City:VAN NUYS
Practice Address - State:CA
Practice Address - Zip Code:91411-2851
Practice Address - Country:US
Practice Address - Phone:818-997-0414
Practice Address - Fax:818-997-0851
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-12
Last Update Date:2015-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA091991101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)