MEDICARE: MS. SUSAN ANN CHAMBERS MARRIAGE AND FAMILY

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	0475	NV

General Provider Information

NPI Number	:	1790876621
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. SUSAN ANN CHAMBERS MARRIAGE AND FAMILY

Provider Business Mailing Address
First Line	:	5836 SO PECOS RD
Second Line	:	# 107
City	:	LAS VEGAS
State	:	NV
Zip	:	89120-3418
Country	:	US
Telephone Number	:	702-944-2032
Fax Number	:	702-944-2033

Provider Business Practice Location Address
First Line	:	5836 SO PECOS RD
Second Line	:	# 107
City	:	LAS VEGAS
State	:	NV
Zip	:	89120-3418
Country	:	US
Telephone Number	:	702-944-2032
Fax Number	:	702-944-2033

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

Provider Enumeration Date	:	09/27/2006
Last Update Date	:	07/08/2007

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