Provider Demographics
NPI:1063189272
Name:CHAMBERS, MADISON (LMHC)
Entity type:Individual
Prefix:
First Name:MADISON
Middle Name:
Last Name:CHAMBERS
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:MADISON
Other - Middle Name:
Other - Last Name:ABNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:996 FALCONER ST NW
Mailing Address - Street 2:
Mailing Address - City:PALM BAY
Mailing Address - State:FL
Mailing Address - Zip Code:32907-7905
Mailing Address - Country:US
Mailing Address - Phone:321-917-0292
Mailing Address - Fax:
Practice Address - Street 1:2123 FRANKLIN DR NE
Practice Address - Street 2:
Practice Address - City:PALM BAY
Practice Address - State:FL
Practice Address - Zip Code:32905-4022
Practice Address - Country:US
Practice Address - Phone:321-724-1614
Practice Address - Fax:321-722-3590
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-25
Last Update Date:2021-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH18568101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health