Provider Demographics
NPI:1306842471
Name:CHASTAIN GITTHENS, RENNIE L (MSW LCSW)
Entity Type:Individual
Prefix:MS
First Name:RENNIE
Middle Name:L
Last Name:CHASTAIN GITTHENS
Suffix:
Gender:F
Credentials:MSW LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1726 8TH AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT JOSEPH
Mailing Address - State:MO
Mailing Address - Zip Code:64505-1811
Mailing Address - Country:US
Mailing Address - Phone:816-262-4494
Mailing Address - Fax:816-364-4737
Practice Address - Street 1:1726 8TH AVE
Practice Address - Street 2:2031 N 36
Practice Address - City:SAINT JOSEPH
Practice Address - State:MO
Practice Address - Zip Code:64505-1811
Practice Address - Country:US
Practice Address - Phone:816-262-4494
Practice Address - Fax:816-364-4737
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-23
Last Update Date:2017-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO0013471041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO493517619Medicaid
MO493517619Medicaid