Provider Demographics
NPI:1861002768
Name:THE CHAMBERS FOR LIFE CHANGE LLC
Entity Type:Organization
Organization Name:THE CHAMBERS FOR LIFE CHANGE LLC
Other - Org Name:KRISTEN CHAMBERS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CLINICAL THERAPIST
Authorized Official - Prefix:MS
Authorized Official - First Name:KRISTEN
Authorized Official - Middle Name:DIANE
Authorized Official - Last Name:CHAMBERS
Authorized Official - Suffix:
Authorized Official - Credentials:LISW-S, LICDC
Authorized Official - Phone:567-218-1207
Mailing Address - Street 1:28367 SIMMONS RD
Mailing Address - Street 2:
Mailing Address - City:PERRYSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:43551-4157
Mailing Address - Country:US
Mailing Address - Phone:567-277-2715
Mailing Address - Fax:
Practice Address - Street 1:118 W SOUTH BOUNDARY ST STE 8
Practice Address - Street 2:
Practice Address - City:PERRYSBURG
Practice Address - State:OH
Practice Address - Zip Code:43551-5103
Practice Address - Country:US
Practice Address - Phone:561-318-2775
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-05
Last Update Date:2024-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health