Provider Demographics
NPI:1093268047
Name:WINCH, CHAD (MA, PLPC)
Entity Type:Individual
Prefix:
First Name:CHAD
Middle Name:
Last Name:WINCH
Suffix:
Gender:M
Credentials:MA, PLPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 S WALLER ST
Mailing Address - Street 2:
Mailing Address - City:DESLOGE
Mailing Address - State:MO
Mailing Address - Zip Code:63601-2810
Mailing Address - Country:US
Mailing Address - Phone:573-330-4452
Mailing Address - Fax:
Practice Address - Street 1:100 S WALLER ST
Practice Address - Street 2:
Practice Address - City:DESLOGE
Practice Address - State:MO
Practice Address - Zip Code:63601-2810
Practice Address - Country:US
Practice Address - Phone:573-330-4452
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-26
Last Update Date:2016-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO002646101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional