Individual
MR. WALTER GILLICAN CHAMBERLAIN JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.ED, LPC, BCBA
Contact information
Practice address
2415 17TH ST, GULFPORT, MS 39501-2906
(228) 701-0085
(220) 701-0054
Mailing address
79321 DIAMONDHEAD DR E, DIAMONDHEAD, MS 39525-3544
(601) 850-8663
(228) 701-0054
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
1548
MS
103K00000X
Behavior Analyst
1-11-9380
—
Other
Enumeration date
10/22/2007
Last updated
11/02/2012
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