Provider Demographics
NPI:1104257070
Name:CHAMBERS, BRIAN (BS, CADC)
Entity type:Individual
Prefix:MR
First Name:BRIAN
Middle Name:
Last Name:CHAMBERS
Suffix:
Gender:M
Credentials:BS, CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 N BENJAMIN LN
Mailing Address - Street 2:SUITE 201
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83704-5094
Mailing Address - Country:US
Mailing Address - Phone:208-287-5630
Mailing Address - Fax:208-287-5609
Practice Address - Street 1:400 N BENJAMIN LN
Practice Address - Street 2:SUITE 201
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83704-5094
Practice Address - Country:US
Practice Address - Phone:208-287-5630
Practice Address - Fax:208-287-5609
Is Sole Proprietor?:No
Enumeration Date:2013-12-03
Last Update Date:2013-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID101YA0400X101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)