Provider Demographics
NPI:1285498071
Name:CHAMBERS, TERRY LEE JR (LPCA, TCADC)
Entity type:Individual
Prefix:
First Name:TERRY
Middle Name:LEE
Last Name:CHAMBERS
Suffix:JR
Gender:M
Credentials:LPCA, TCADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3934 DIXIE HWY # 201
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40216-4163
Mailing Address - Country:US
Mailing Address - Phone:502-709-5029
Mailing Address - Fax:
Practice Address - Street 1:3934 DIXIE HIGH WAY
Practice Address - Street 2:201
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40216
Practice Address - Country:US
Practice Address - Phone:502-709-5029
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-12
Last Update Date:2024-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY281200101Y00000X
KY246305101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor