Provider Demographics
NPI:1609513191
Name:TINNEY, CHANTA S (LMSW)
Entity Type:Individual
Prefix:
First Name:CHANTA
Middle Name:S
Last Name:TINNEY
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:224 W MAPLE AVE
Mailing Address - Street 2:
Mailing Address - City:INDEPENDENCE
Mailing Address - State:MO
Mailing Address - Zip Code:64050-2816
Mailing Address - Country:US
Mailing Address - Phone:816-381-7690
Mailing Address - Fax:816-381-7652
Practice Address - Street 1:224 W MAPLE AVE
Practice Address - Street 2:
Practice Address - City:INDEPENDENCE
Practice Address - State:MO
Practice Address - Zip Code:64050-2816
Practice Address - Country:US
Practice Address - Phone:816-381-7690
Practice Address - Fax:816-381-7652
Is Sole Proprietor?:No
Enumeration Date:2022-05-16
Last Update Date:2022-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2021043399104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker