Healthcare Provider Details

I. General information

NPI: 1265049670
Provider Name (Legal Business Name): MELISSA ANNE CHAMBERS LMHC MH 18433; MS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/29/2020
Last Update Date: 05/02/2025
Certification Date: 05/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

421 W OAK AVE
PANAMA CITY FL
32401-2737
US

IV. Provider business mailing address

421 W OAK AVE
PANAMA CITY FL
32401-2737
US

V. Phone/Fax

Practice location:
  • Phone: 850-769-6001
  • Fax: 850-769-6003
Mailing address:
  • Phone: 850-769-6001
  • Fax: 850-769-6003

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH18433
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: