MEDICARE: CHAMBERS FOR LIFE CHANGE

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	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1861002768
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHAMBERS FOR LIFE CHANGE

Provider Business Mailing Address
First Line	:	3244 CHASENWOOD WAY
Second Line	:
City	:	PERRYSBURG
State	:	OH
Zip	:	43551-6942
Country	:	US
Telephone Number	:	567-277-2715
Fax Number	:

Provider Business Practice Location Address
First Line	:	118 W SOUTH BOUNDARY ST
Second Line	:
City	:	PERRYSBURG
State	:	OH
Zip	:	43551-5102
Country	:	US
Telephone Number	:	567-218-1207
Fax Number	:

Authorized Official
Title or Position	:	CLINICAL THERAPIST
Name	:	KRISTEN DIANE BLESSING
Credential	:
Telephone Number	:	567-218-1207

Provider Enumeration Date	:	08/05/2020
Last Update Date	:	02/05/2026

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Directions to “CHAMBERS FOR LIFE CHANGE ” Practice Location

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