Provider Demographics
NPI:1245393081
Name:CHACKES-TONOPOLSKY, LAURA M (PSY D)
Entity Type:Individual
Prefix:DR
First Name:LAURA
Middle Name:M
Last Name:CHACKES-TONOPOLSKY
Suffix:
Gender:F
Credentials:PSY D
Other - Prefix:DR
Other - First Name:LAURA
Other - Middle Name:M
Other - Last Name:CHACKES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PSY D
Mailing Address - Street 1:10845 OLIVE BLVD STE 150
Mailing Address - Street 2:
Mailing Address - City:CREVE COEUR
Mailing Address - State:MO
Mailing Address - Zip Code:63141-7760
Mailing Address - Country:US
Mailing Address - Phone:314-561-9757
Mailing Address - Fax:314-561-9050
Practice Address - Street 1:10845 OLIVE BLVD STE 150
Practice Address - Street 2:
Practice Address - City:CREVE COEUR
Practice Address - State:MO
Practice Address - Zip Code:63141-7760
Practice Address - Country:US
Practice Address - Phone:314-561-9757
Practice Address - Fax:314-561-9050
Is Sole Proprietor?:No
Enumeration Date:2006-12-19
Last Update Date:2017-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2006027463103TB0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral