Provider Demographics
NPI:1336916618
Name:CHAMBERS, RANDALL ELIZABETH (RBT)
Entity Type:Individual
Prefix:
First Name:RANDALL
Middle Name:ELIZABETH
Last Name:CHAMBERS
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2620 FORUM BLVD
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65203-5430
Mailing Address - Country:US
Mailing Address - Phone:573-514-8735
Mailing Address - Fax:573-722-2133
Practice Address - Street 1:2620 FORUM BLVD
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65203-5430
Practice Address - Country:US
Practice Address - Phone:573-514-8735
Practice Address - Fax:573-722-2133
Is Sole Proprietor?:No
Enumeration Date:2023-12-07
Last Update Date:2023-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MORBT-23-314862106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician