Provider Demographics
NPI:1689793457
Name:CHAMBERS, CAROL ANN (MFT)
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:ANN
Last Name:CHAMBERS
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:43713 20TH ST W
Mailing Address - Street 2:SUITE 5
Mailing Address - City:LANCASTER
Mailing Address - State:CA
Mailing Address - Zip Code:93534-4628
Mailing Address - Country:US
Mailing Address - Phone:661-948-0871
Mailing Address - Fax:
Practice Address - Street 1:43713 20TH ST W
Practice Address - Street 2:SUITE 5
Practice Address - City:LANCASTER
Practice Address - State:CA
Practice Address - Zip Code:93534-4628
Practice Address - Country:US
Practice Address - Phone:661-948-0871
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-29
Last Update Date:2010-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
CA48431106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health