MEDICARE: DR. MARK J. CHAMBERS PH.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	PY267	NV

General Provider Information

NPI Number	:	1033218540
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARK J. CHAMBERS PH.D.

Provider Business Mailing Address
First Line	:	8275 S EASTERN AVE
Second Line	:	SUITE 200
City	:	LAS VEGAS
State	:	NV
Zip	:	89123-2591
Country	:	US
Telephone Number	:	702-614-4550
Fax Number	:	702-938-1042

Provider Business Practice Location Address
First Line	:	8275 S EASTERN AVE
Second Line	:	SUITE 200
City	:	LAS VEGAS
State	:	NV
Zip	:	89123-2591
Country	:	US
Telephone Number	:	702-614-4550
Fax Number	:	702-938-1042

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/21/2006
Last Update Date	:	07/09/2007

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