Healthcare Provider Details

I. General information

NPI: 1982921425
Provider Name (Legal Business Name): THOMAS B. CHAFFIN LSCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/23/2010
Last Update Date: 04/23/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

550 POPE AVE. MUNSON ARMY HEALTH CENTER (ATTN: MCXN-COD, MS. COTTON
FORT LEAVENWORTH KS
66027-2332
US

IV. Provider business mailing address

550 POPE AVE MUNSON ARMY HEALTH CENTER (ATTN: MCXN-COD, MS. COTTON
FORT LEAVENWORTH KS
66027-2332
US

V. Phone/Fax

Practice location:
  • Phone: 913-684-6562
  • Fax: 913-684-6562
Mailing address:
  • Phone: 913-684-6562
  • Fax: 913-684-7440

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLSCSW: 2117
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: