Provider Demographics
NPI:1871527267
Name:CHAMBERS, HARVEY E (CP)
Entity type:Individual
Prefix:
First Name:HARVEY
Middle Name:E
Last Name:CHAMBERS
Suffix:
Gender:M
Credentials:CP
Other - Prefix:
Other - First Name:GENE
Other - Middle Name:
Other - Last Name:CHAMBERS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHD
Mailing Address - Street 1:2592 N GREGG AVE STE 16
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72703-5541
Mailing Address - Country:US
Mailing Address - Phone:479-313-6333
Mailing Address - Fax:479-313-6168
Practice Address - Street 1:2592 N GREGG AVE STE 16
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:AR
Practice Address - Zip Code:72703-5541
Practice Address - Country:US
Practice Address - Phone:479-313-6333
Practice Address - Fax:479-313-6168
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-10
Last Update Date:2017-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR93-19P103G00000X
AR9319P103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR123650719Medicaid
AR5S606Medicare PIN