Provider Demographics
NPI:1831740299
Name:KRISTEN CHAMBLISS, PH.D., PLLC
Entity type:Organization
Organization Name:KRISTEN CHAMBLISS, PH.D., PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSE PSYCHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:KRISTEN
Authorized Official - Middle Name:
Authorized Official - Last Name:CHAMBLISS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-324-0503
Mailing Address - Street 1:1506 E. WINDING WAY DR.
Mailing Address - Street 2:SUITE 606
Mailing Address - City:FRIENDSWOOD
Mailing Address - State:TX
Mailing Address - Zip Code:77546
Mailing Address - Country:US
Mailing Address - Phone:281-324-0503
Mailing Address - Fax:
Practice Address - Street 1:1506 E. WINDING WAY DR.
Practice Address - Street 2:SUITE 606
Practice Address - City:FRIENDSWOOD
Practice Address - State:TX
Practice Address - Zip Code:77546
Practice Address - Country:US
Practice Address - Phone:281-324-0503
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-26
Last Update Date:2019-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
No103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounselingGroup - Multi-Specialty