MEDICARE: KELLY A CHAMBERS

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	101YM0800X	Mental Health Counselor	C.1901879	OH

General Provider Information

NPI Number	:	1427551019
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KELLY A CHAMBERS

Provider Business Mailing Address
First Line	:	1385 KING AVE
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43212-2220
Country	:	US
Telephone Number	:	740-602-2204
Fax Number	:

Provider Business Practice Location Address
First Line	:	1385 KING AVE
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43212-2220
Country	:	US
Telephone Number	:	740-602-2204
Fax Number	:

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

Provider Enumeration Date	:	03/09/2018
Last Update Date	:	05/11/2021

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Directions to “ KELLY A CHAMBERS ” Practice Location

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