MEDICARE: GAYLA CHAMBERS PLMHP

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	106H00000X	Marriage & Family Therapist	7875	NE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	7875	OTHER	NE	STATE LICENSE

General Provider Information

NPI Number	:	1801957774
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GAYLA CHAMBERS PLMHP

Provider Business Mailing Address
First Line	:	2505 N 24TH ST
Second Line	:
City	:	OMAHA
State	:	NE
Zip	:	68110-2252
Country	:	US
Telephone Number	:	402-451-5549
Fax Number	:

Provider Business Practice Location Address
First Line	:	2505 N 24TH ST
Second Line	:
City	:	OMAHA
State	:	NE
Zip	:	68110-2252
Country	:	US
Telephone Number	:	402-451-5549
Fax Number	:

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

Provider Enumeration Date	:	12/13/2006
Last Update Date	:	07/08/2007

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