Provider Demographics
NPI:1548465172
Name:CHAMBERLAIN, WILLADEEN (MED, LPC)
Entity type:Individual
Prefix:
First Name:WILLADEEN
Middle Name:
Last Name:CHAMBERLAIN
Suffix:
Gender:F
Credentials:MED, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9508 YELLOWSTONE RD
Mailing Address - Street 2:
Mailing Address - City:CHEYENNE
Mailing Address - State:WY
Mailing Address - Zip Code:82009-8942
Mailing Address - Country:US
Mailing Address - Phone:307-632-2744
Mailing Address - Fax:
Practice Address - Street 1:320 W 25TH ST STE 318
Practice Address - Street 2:
Practice Address - City:CHEYENNE
Practice Address - State:WY
Practice Address - Zip Code:82001-3005
Practice Address - Country:US
Practice Address - Phone:307-631-6527
Practice Address - Fax:307-778-1216
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY417101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional