MEDICARE: MARY BETH CHAMBERS-WOODS LPC

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	C5882	OH
2	101YP2500X	Professional Counselor

General Provider Information

NPI Number	:	1578550315
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARY BETH CHAMBERS-WOODS LPC

Provider Business Mailing Address
First Line	:	6400 E BROAD ST
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43213-2086
Country	:	US
Telephone Number	:	614-655-3345
Fax Number	:	614-317-4689

Provider Business Practice Location Address
First Line	:	6400 E BROAD ST
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43213-2086
Country	:	US
Telephone Number	:	614-655-3345
Fax Number	:	614-317-4689

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

Provider Enumeration Date	:	10/05/2005
Last Update Date	:	12/04/2019

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