Healthcare Provider Details

I. General information

NPI: 1538453097
Provider Name (Legal Business Name): TIMOTHY CHANCE CHOATE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/01/2011
Last Update Date: 12/18/2025
Certification Date: 12/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

702 HUDSON RD
SAINT LOUIS MO
63135-1338
US

IV. Provider business mailing address

702 HUDSON RD
SAINT LOUIS MO
63135-1338
US

V. Phone/Fax

Practice location:
  • Phone: 314-252-8620
  • Fax:
Mailing address:
  • Phone: 615-946-3426
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: