Provider Demographics
NPI:1730842881
Name:GRIFFIN, CHAD ELDON (PLPC)
Entity type:Individual
Prefix:MR
First Name:CHAD
Middle Name:ELDON
Last Name:GRIFFIN
Suffix:
Gender:M
Credentials:PLPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1805 SPRINGHILL DR
Mailing Address - Street 2:
Mailing Address - City:O FALLON
Mailing Address - State:MO
Mailing Address - Zip Code:63366-3930
Mailing Address - Country:US
Mailing Address - Phone:636-544-0848
Mailing Address - Fax:
Practice Address - Street 1:1137 N MAIN ST STE 2
Practice Address - Street 2:
Practice Address - City:O FALLON
Practice Address - State:MO
Practice Address - Zip Code:63366-1498
Practice Address - Country:US
Practice Address - Phone:636-294-2694
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-15
Last Update Date:2021-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2021040936101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional