Healthcare Provider Details

I. General information

NPI: 1912593690
Provider Name (Legal Business Name): LEAH MARIE CHAMBERS LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/16/2020
Last Update Date: 10/25/2024
Certification Date: 10/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8137 SE SHORT RD
GRESHAM OR
97080-8206
US

IV. Provider business mailing address

8137 SE SHORT RD
GRESHAM OR
97080-8206
US

V. Phone/Fax

Practice location:
  • Phone: 503-660-8103
  • Fax:
Mailing address:
  • Phone: 503-660-8103
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLH61497317
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberC6942
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: