Healthcare Provider Details

I. General information

NPI: 1841564978
Provider Name (Legal Business Name): DEREK JOSEPH CHAMBERLAIN LCMHC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/07/2012
Last Update Date: 05/28/2024
Certification Date: 01/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2920 N GREEN VALLEY PKWY STE 312
HENDERSON NV
89014-0412
US

IV. Provider business mailing address

2780 S JONES BLVD STE 115D
LAS VEGAS NV
89146-5625
US

V. Phone/Fax

Practice location:
  • Phone: 702-935-0025
  • Fax: 702-935-0008
Mailing address:
  • Phone: 702-935-0025
  • Fax: 702-935-0008

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCP0162
License Number StateNV
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberCP0162
License Number StateNV
# 3
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number1169
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: