Provider Demographics
NPI:1760547798
Name:CHAMBERLAIN, LEON EARLY III
Entity Type:Individual
Prefix:
First Name:LEON
Middle Name:EARLY
Last Name:CHAMBERLAIN
Suffix:III
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:243 NATURAL BRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:DOUGLAS
Mailing Address - State:WY
Mailing Address - Zip Code:82633-9237
Mailing Address - Country:US
Mailing Address - Phone:307-358-5895
Mailing Address - Fax:
Practice Address - Street 1:1030 N POPLAR ST
Practice Address - Street 2:
Practice Address - City:CASPER
Practice Address - State:WY
Practice Address - Zip Code:82601-1378
Practice Address - Country:US
Practice Address - Phone:307-261-5355
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WYLCSW 2981041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical