MEDICARE: TAYLOR CHAMBERS MS, LMFT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106H00000X	Marriage & Family Therapist	8764520-3904	UT

General Provider Information

NPI Number	:	1235556440
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TAYLOR CHAMBERS MS, LMFT

Provider Business Mailing Address
First Line	:	65 W CENTER ST APT 11
Second Line	:
City	:	IVINS
State	:	UT
Zip	:	84738-5901
Country	:	US
Telephone Number	:	541-633-5719
Fax Number	:

Provider Business Practice Location Address
First Line	:	393 E RIVERSIDE DR STE 3A
Second Line	:
City	:	SAINT GEORGE
State	:	UT
Zip	:	84790-7127
Country	:	US
Telephone Number	:	541-633-5719
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/25/2014
Last Update Date	:	06/06/2016

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