Doctor Name: | CHAD D CUNNINGHAM |
NPI Number: | 1619165966 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | |
License Number: | 2007010482 |
Business Practice Address: | 422 Parkgate Dr Lake Saint Louis, MO - 633674379 |
Business Phone Number: | 6368666246 |
Business Fax Number: | 6366250123 |
Mailing Address: | 422 Parkgate Dr, LAKE SAINT LOUIS |
State: | MO |
Postal Code: | 633674379 |
Phone Number: | 6368666246 |
Fax Number: | 6366250123 |
NPI Enumeration Date: | 10/11/2007 |
NPI Last Update Date: | 06/13/2011 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YP2500X |
License Number: | 2007010482 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MO |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Professional |
Taxonomy Definition: |