Healthcare Provider Details

I. General information

NPI: 1104226182
Provider Name (Legal Business Name): CAROL SUSAN CHAMBERS PSYD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/27/2014
Last Update Date: 04/22/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 CROWN POINT CIR SUITE 120
GRASS VALLEY CA
95945-9561
US

IV. Provider business mailing address

16154 INDIAN FLAT RD
NEVADA CITY CA
95959-8703
US

V. Phone/Fax

Practice location:
  • Phone: 530-265-1437
  • Fax:
Mailing address:
  • Phone: 530-635-1996
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number27159
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: