Provider Demographics
NPI:1992976450
Name:CHAMBERS, HEIDI GAIL (MA)
Entity type:Individual
Prefix:
First Name:HEIDI
Middle Name:GAIL
Last Name:CHAMBERS
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:531 SE TOTTEN SHORES DR
Mailing Address - Street 2:
Mailing Address - City:SHELTON
Mailing Address - State:WA
Mailing Address - Zip Code:98584-8353
Mailing Address - Country:US
Mailing Address - Phone:360-432-9217
Mailing Address - Fax:
Practice Address - Street 1:103 S 4TH ST STE 202
Practice Address - Street 2:
Practice Address - City:SHELTON
Practice Address - State:WA
Practice Address - Zip Code:98584-3574
Practice Address - Country:US
Practice Address - Phone:360-349-1488
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-12
Last Update Date:2010-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH00005070101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health