Provider Demographics
NPI:1780180752
Name:CHAMBERS, ELIZABETH ROSE (LMSW)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:ROSE
Last Name:CHAMBERS
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:ELIZABETH
Other - Middle Name:ROSE
Other - Last Name:MILES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMSW
Mailing Address - Street 1:6194 INDEPENDENCE DR
Mailing Address - Street 2:
Mailing Address - City:PORTAGE
Mailing Address - State:MI
Mailing Address - Zip Code:49024-2643
Mailing Address - Country:US
Mailing Address - Phone:269-369-7893
Mailing Address - Fax:
Practice Address - Street 1:391 S SHORE DR STE 214
Practice Address - Street 2:
Practice Address - City:BATTLE CREEK
Practice Address - State:MI
Practice Address - Zip Code:49014-5446
Practice Address - Country:US
Practice Address - Phone:269-964-0153
Practice Address - Fax:855-877-5812
Is Sole Proprietor?:No
Enumeration Date:2018-03-30
Last Update Date:2018-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801091384104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker