Provider Demographics
NPI:1386963858
Name:CHAMBLISS, KRISTEN HEATHER (PHD)
Entity type:Individual
Prefix:DR
First Name:KRISTEN
Middle Name:HEATHER
Last Name:CHAMBLISS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1560 W BAY AREA BLVD
Mailing Address - Street 2:SUITE 270
Mailing Address - City:FRIENDSWOOD
Mailing Address - State:TX
Mailing Address - Zip Code:77546-2667
Mailing Address - Country:US
Mailing Address - Phone:281-480-0200
Mailing Address - Fax:
Practice Address - Street 1:1560 W BAY AREA BLVD
Practice Address - Street 2:SUITE 270
Practice Address - City:FRIENDSWOOD
Practice Address - State:TX
Practice Address - Zip Code:77546-2667
Practice Address - Country:US
Practice Address - Phone:281-480-0200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-24
Last Update Date:2011-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX34555103TB0200X, 103TC1900X, 103TH0004X, 103K00000X, 101Y00000X, 101YA0400X, 101YM0800X, 101YP2500X, 103T00000X, 103TA0400X, 103TA0700X, 103TP2701X, 103TM1800X, 103TH0100X
103TH0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TH0004XBehavioral Health & Social Service ProvidersPsychologistHealth
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
No103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TA0400XBehavioral Health & Social Service ProvidersPsychologistAddiction (Substance Use Disorder)
No103TA0700XBehavioral Health & Social Service ProvidersPsychologistAdult Development & Aging
No103TP2701XBehavioral Health & Social Service ProvidersPsychologistGroup Psychotherapy
No103TM1800XBehavioral Health & Social Service ProvidersPsychologistIntellectual & Developmental Disabilities
No103TH0100XBehavioral Health & Social Service ProvidersPsychologistHealth Service