Provider Demographics
NPI:1205107752
Name:CHAMBLESS, GRETA OTT (EDS)
Entity type:Individual
Prefix:MRS
First Name:GRETA
Middle Name:OTT
Last Name:CHAMBLESS
Suffix:
Gender:F
Credentials:EDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5950 CARMICHAEL PL
Mailing Address - Street 2:SUITE 100
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36117-2348
Mailing Address - Country:US
Mailing Address - Phone:334-262-5744
Mailing Address - Fax:334-262-5155
Practice Address - Street 1:5950 CARMICHAEL PL
Practice Address - Street 2:SUITE 100
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36117-2348
Practice Address - Country:US
Practice Address - Phone:334-262-5744
Practice Address - Fax:334-262-5155
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-14
Last Update Date:2012-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALC1507A101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor