Provider Demographics
NPI:1235599341
Name:CASSELL, CHALENNA C (PSYD)
Entity Type:Individual
Prefix:DR
First Name:CHALENNA
Middle Name:C
Last Name:CASSELL
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1034 BRAMBLETT XING
Mailing Address - Street 2:
Mailing Address - City:O FALLON
Mailing Address - State:MO
Mailing Address - Zip Code:63366-3253
Mailing Address - Country:US
Mailing Address - Phone:404-769-2242
Mailing Address - Fax:
Practice Address - Street 1:1551 WALL ST
Practice Address - Street 2:
Practice Address - City:SAINT CHARLES
Practice Address - State:MO
Practice Address - Zip Code:63303-3539
Practice Address - Country:US
Practice Address - Phone:404-769-2242
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-02
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2016001951103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical