Provider Demographics
NPI:1477792638
Name:MEHL CHADWICK, KATHLEEN ANN (PHD, LPC)
Entity Type:Individual
Prefix:DR
First Name:KATHLEEN
Middle Name:ANN
Last Name:MEHL CHADWICK
Suffix:
Gender:F
Credentials:PHD, LPC
Other - Prefix:
Other - First Name:KATHLEEN
Other - Middle Name:ANN
Other - Last Name:MEHL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC
Mailing Address - Street 1:103 N CLAYVIEW DR
Mailing Address - Street 2:WESTOWNE 2, CHADWICK PROFESSIONAL OFFICES
Mailing Address - City:LIBERTY
Mailing Address - State:MO
Mailing Address - Zip Code:64068-1116
Mailing Address - Country:US
Mailing Address - Phone:816-797-9437
Mailing Address - Fax:816-502-0477
Practice Address - Street 1:103 N CLAYVIEW DR
Practice Address - Street 2:WESTOWNE 2, CHADWICK PROFESSIONAL OFFICES
Practice Address - City:LIBERTY
Practice Address - State:MO
Practice Address - Zip Code:64068-1116
Practice Address - Country:US
Practice Address - Phone:816-797-9437
Practice Address - Fax:816-502-0477
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-11
Last Update Date:2009-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO000265101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional