Healthcare Provider Details

I. General information

NPI: 1881508901
Provider Name (Legal Business Name): CHANTAL AMBERSLEY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/29/2026
Last Update Date: 09/29/2026
Certification Date: 09/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17235 N 75TH AVE STE F110
GLENDALE AZ
85308-0872
US

IV. Provider business mailing address

14006 N 130TH DR
EL MIRAGE AZ
85335-5310
US

V. Phone/Fax

Practice location:
  • Phone: 928-792-1723
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: