Healthcare Provider Details

I. General information

NPI: 1124412903
Provider Name (Legal Business Name): MARDI L CHAMBERS LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MARDI L MCHUGH LCSW

II. Dates (important events)

Enumeration Date: 03/19/2015
Last Update Date: 07/31/2026
Certification Date: 07/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7166 COUNTY ROAD 154
SALIDA CO
81201-9455
US

IV. Provider business mailing address

7166 COUNTY ROAD 154
SALIDA CO
81201-9455
US

V. Phone/Fax

Practice location:
  • Phone: 719-276-5488
  • Fax:
Mailing address:
  • Phone: 719-276-5488
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCSW.00992884
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: