MEDICARE: TASHAWNA ELAINE 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	101YA0400X	Addiction (Substance Use Disorder) Counselor	157753	CA

General Provider Information

NPI Number	:	1811606544
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TASHAWNA ELAINE CHAMBERS

Provider Business Mailing Address
First Line	:	1117 W 93RD ST
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90044-3319
Country	:	US
Telephone Number	:	323-952-0903
Fax Number	:

Provider Business Practice Location Address
First Line	:	1117 W 93RD ST
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90044-3319
Country	:	US
Telephone Number	:	323-952-0903
Fax Number	:

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

Provider Enumeration Date	:	11/21/2022
Last Update Date	:	11/21/2022

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Directions to “ TASHAWNA ELAINE CHAMBERS ” Practice Location

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