Healthcare Provider Details

I. General information

NPI: 1538082250
Provider Name (Legal Business Name): MARK CHAMBERS LMSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/31/2026
Last Update Date: 07/31/2026
Certification Date: 07/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

219 W ASPEN WAY
SNOWFLAKE AZ
85937-5540
US

IV. Provider business mailing address

219 W ASPEN WAY
SNOWFLAKE AZ
85937-5540
US

V. Phone/Fax

Practice location:
  • Phone: 602-301-5218
  • Fax:
Mailing address:
  • Phone: 602-301-5218
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLMSW-17673
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: