=====================================================
General NPI Number Information
=====================================================
NPI Number | 1700814480
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | THOMAS CAREY CHAMBERLIN PSY.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/29/2006
-----------------------------------------------------
Last Update Date | 10/28/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 11398 W WOLF TOOTH PASS
-----------------------------------------------------
City | LITTLETON
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80127-4027
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 720-260-8919
-----------------------------------------------------
Fax | 720-981-9453
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 270568
-----------------------------------------------------
City | LITTLETON
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80127-0010
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 720-260-8919
-----------------------------------------------------
Fax | 720-981-9453
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103T00000X
-----------------------------------------------------
Taxonomy Name | Psychologist
-----------------------------------------------------
License Number | 1880
-----------------------------------------------------
License Number State | CO
-----------------------------------------------------