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General NPI Number Information
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NPI Number | 1760701296
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Entity Type | Individual
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Provider Name | GARY CORTLAND CHADWICK LPC
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Gender | Male
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Dates
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Enumeration Date | 05/24/2010
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Last Update Date | 07/28/2023
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Provider Practice Location Address
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Address Line | 10 S EUCLID AVE STE C
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City | SAINT LOUIS
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State | MO
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Zip | 63108-3809
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Country | US
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Telephone | 617-379-0496
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Fax |
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Provider Business Mailing Address
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Address Line | 5761 S CLAY AVE
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City | SPRINGFIELD
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State | MO
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Zip | 65810-2911
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Country | US
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Telephone | 816-284-0108
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 2010027858
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License Number State |
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