Provider Demographics
NPI:1811239452
Name:CHAMBERS, TRACIE R (LCSW)
Entity Type:Individual
Prefix:
First Name:TRACIE
Middle Name:R
Last Name:CHAMBERS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:TRA'RENEE
Other - Middle Name:
Other - Last Name:CHAMBERS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW
Mailing Address - Street 1:3920 N KERBY AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97227-1255
Mailing Address - Country:US
Mailing Address - Phone:503-249-1721
Mailing Address - Fax:
Practice Address - Street 1:3920 N KERBY AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97227-1255
Practice Address - Country:US
Practice Address - Phone:503-249-1721
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-21
Last Update Date:2013-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORL52661041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical