Provider Demographics
NPI:1730757485
Name:CHISM, DAVID ANDREW (LPC)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:ANDREW
Last Name:CHISM
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 PROSPECT AVENUE
Mailing Address - Street 2:SUITE 203, ROOM A
Mailing Address - City:KIRKWOOD
Mailing Address - State:MO
Mailing Address - Zip Code:63122-6067
Mailing Address - Country:US
Mailing Address - Phone:314-591-0273
Mailing Address - Fax:
Practice Address - Street 1:111 PROSPECT AVENUE
Practice Address - Street 2:SUITE 203, ROOM A
Practice Address - City:KIRKWOOD
Practice Address - State:MO
Practice Address - Zip Code:63122-6067
Practice Address - Country:US
Practice Address - Phone:314-591-0273
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-17
Last Update Date:2024-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2021001879101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health