Provider Demographics
NPI:1790458941
Name:STOKES, CHANDIS (BCBA)
Entity Type:Individual
Prefix:
First Name:CHANDIS
Middle Name:
Last Name:STOKES
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10093 ASHBROOK DR
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63137-1506
Mailing Address - Country:US
Mailing Address - Phone:314-957-8026
Mailing Address - Fax:
Practice Address - Street 1:8130 BALSON AVE
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63130-3607
Practice Address - Country:US
Practice Address - Phone:314-410-9670
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-25
Last Update Date:2021-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO1-21-51809103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst