Active NPI
Richard Wade Chamberlin, LMFT
- Marriage & Family Therapist
- Anoka, MN
National Provider Identifier
1003874009
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Marriage & Family Therapist
- License
- 1313
- Practice address
- 12 Bridge SQ Ste 207
Anoka, MN 55303 - Phone
- (952) 693-8220
- NPI assigned
- May 2, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Marriage & Family Therapist | 106H00000X | 1313 | MN | Primary |
Addresses
Primary practice location
12 Bridge SQ Ste 207
Anoka, MN 55303
Mailing address
12 Bridge SQ
Ste 207
Anoka, MN 55303
Phone (952) 693-8220
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 817981600 | Medicaid | MN |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1313 | MN | MD | Marriage & Family Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1146528000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1534896000000",
"number": "1003874009",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "12 BRIDGE SQ",
"address_2": "STE 207",
"city": "ANOKA",
"state": "MN",
"postal_code": "55303",
"telephone_number": "952-693-8220",
"fax_number": "763-712-9200"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "12 BRIDGE SQ STE 207",
"city": "ANOKA",
"state": "MN",
"postal_code": "55303",
"telephone_number": "952-693-8220"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CHAMBERLIN",
"first_name": "RICHARD",
"middle_name": "WADE",
"name_prefix": "Mr.",
"credential": "LMFT",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-05-02",
"last_updated": "2018-08-22",
"status": "A"
},
"taxonomies": [
{
"code": "106H00000X",
"taxonomy_group": "",
"desc": "Marriage & Family Therapist",
"state": "MN",
"license": "1313",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "817981600",
"state": "MN"
}
],
"endpoints": [],
"other_names": []
}Other providers in Anoka, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.