Provider Demographics
NPI:1609040963
Name:CHAMBERS, PAIGE WILSON (LCSW-ACP)
Entity Type:Individual
Prefix:
First Name:PAIGE
Middle Name:WILSON
Last Name:CHAMBERS
Suffix:
Gender:F
Credentials:LCSW-ACP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3131 SANGUINET ST
Mailing Address - Street 2:ATT: CREDENTIALNG
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76107-5336
Mailing Address - Country:US
Mailing Address - Phone:817-255-2670
Mailing Address - Fax:817-735-4640
Practice Address - Street 1:3800 HULEN ST STE 150
Practice Address - Street 2:ATT: CREDENTIALNG
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76107-7254
Practice Address - Country:US
Practice Address - Phone:817-255-2670
Practice Address - Fax:817-735-4640
Is Sole Proprietor?:No
Enumeration Date:2008-04-17
Last Update Date:2009-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX345801041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX196125201Medicaid