Healthcare Provider Details

I. General information

NPI: 1598013104
Provider Name (Legal Business Name): LORRIE H CHAFIN LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/29/2012
Last Update Date: 09/22/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

622 W STEEL ST
SEYMOUR MO
65746-8836
US

IV. Provider business mailing address

622 W STEEL ST
SEYMOUR MO
65746-8836
US

V. Phone/Fax

Practice location:
  • Phone: 417-630-9037
  • Fax:
Mailing address:
  • Phone: 417-630-9037
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number2002002478
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: