Provider Demographics
NPI:1225463490
Name:HERRON, CHANDA L (LCSW)
Entity Type:Individual
Prefix:
First Name:CHANDA
Middle Name:L
Last Name:HERRON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 MARKET ST STE 101
Mailing Address - Street 2:
Mailing Address - City:FULTON
Mailing Address - State:MO
Mailing Address - Zip Code:65251-2808
Mailing Address - Country:US
Mailing Address - Phone:573-591-1514
Mailing Address - Fax:573-642-0087
Practice Address - Street 1:500 MARKET ST STE 101
Practice Address - Street 2:
Practice Address - City:FULTON
Practice Address - State:MO
Practice Address - Zip Code:65251-2808
Practice Address - Country:US
Practice Address - Phone:573-591-1514
Practice Address - Fax:573-642-0087
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-06
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20130321851041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical