Provider Demographics
NPI:1053469171
Name:SMITH, CHESTER OVERBAY (MED, LPC)
Entity Type:Individual
Prefix:MR
First Name:CHESTER
Middle Name:OVERBAY
Last Name:SMITH
Suffix:
Gender:M
Credentials:MED, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:225 S MERAMEC AVE
Mailing Address - Street 2:SUITE 214
Mailing Address - City:CLAYTON
Mailing Address - State:MO
Mailing Address - Zip Code:63105-3511
Mailing Address - Country:US
Mailing Address - Phone:314-721-7885
Mailing Address - Fax:314-721-3611
Practice Address - Street 1:225 S MERAMEC AVE
Practice Address - Street 2:SUITE 214
Practice Address - City:CLAYTON
Practice Address - State:MO
Practice Address - Zip Code:63105-3511
Practice Address - Country:US
Practice Address - Phone:314-721-7885
Practice Address - Fax:314-721-3611
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO000726101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO11545373OtherCAQH UNIVERSAL CREDENTIAL