Provider Demographics
NPI:1982057279
Name:CHAMBERS, BRITTANY
Entity Type:Individual
Prefix:
First Name:BRITTANY
Middle Name:
Last Name:CHAMBERS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3055 KETTERING BLVD
Mailing Address - Street 2:311
Mailing Address - City:MORAINE
Mailing Address - State:OH
Mailing Address - Zip Code:45439-1989
Mailing Address - Country:US
Mailing Address - Phone:937-424-0210
Mailing Address - Fax:
Practice Address - Street 1:3055 KETTERING BLVD
Practice Address - Street 2:311
Practice Address - City:MORAINE
Practice Address - State:OH
Practice Address - Zip Code:45439-1989
Practice Address - Country:US
Practice Address - Phone:937-424-0210
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-21
Last Update Date:2016-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHC.1500566101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health