Provider Demographics
NPI:1457583445
Name:CHAMBLIN, LACEY M (LMFT)
Entity Type:Individual
Prefix:
First Name:LACEY
Middle Name:M
Last Name:CHAMBLIN
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1240 SHANE LN
Mailing Address - Street 2:
Mailing Address - City:TEMPLETON
Mailing Address - State:CA
Mailing Address - Zip Code:93465-3614
Mailing Address - Country:US
Mailing Address - Phone:805-610-9298
Mailing Address - Fax:
Practice Address - Street 1:1240 SHANE LN
Practice Address - Street 2:
Practice Address - City:TEMPLETON
Practice Address - State:CA
Practice Address - Zip Code:93465-3614
Practice Address - Country:US
Practice Address - Phone:805-610-9298
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-08-10
Last Update Date:2023-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALMFT97451106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist