Healthcare Provider Details

I. General information

NPI: 1275257677
Provider Name (Legal Business Name): CHRIS LAWRENCE, PHD & ASSOCIATES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/29/2022
Last Update Date: 09/29/2022
Certification Date: 09/29/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 W BROADWAY STE F
COLUMBIA MO
65203-3842
US

IV. Provider business mailing address

201 W BROADWAY STE F
COLUMBIA MO
65203-3842
US

V. Phone/Fax

Practice location:
  • Phone: 573-214-0436
  • Fax: 573-442-0606
Mailing address:
  • Phone: 573-214-0436
  • Fax: 573-442-0606

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: CHRIS LAWRENCE
Title or Position: DIRECTOR
Credential: PH.D.
Phone: 573-214-0436