Provider Demographics
NPI:1457401309
Name:CHAMBLISS, LANA N (PHD)
Entity type:Individual
Prefix:DR
First Name:LANA
Middle Name:N
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:PO BOX 791418
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70179-1418
Mailing Address - Country:US
Mailing Address - Phone:504-252-0511
Mailing Address - Fax:
Practice Address - Street 1:1050 S JEFFERSON DAVIS PKWY
Practice Address - Street 2:SUITE 239
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70125-1200
Practice Address - Country:US
Practice Address - Phone:504-252-0511
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-11
Last Update Date:2014-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA797103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical