Healthcare Provider Details

I. General information

NPI: 1134726839
Provider Name (Legal Business Name): TOMMY CHAMBERS LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/06/2020
Last Update Date: 10/06/2020
Certification Date: 10/06/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1300 N 6TH ST
LONGVIEW TX
75601-5567
US

IV. Provider business mailing address

107 WOODBINE PL
LONGVIEW TX
75601-2912
US

V. Phone/Fax

Practice location:
  • Phone: 903-297-1852
  • Fax: 903-234-1639
Mailing address:
  • Phone: 903-758-2471
  • Fax: 903-234-1639

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number81463
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: