Provider Demographics
NPI:1881738748
Name:THOMAS-CHAPMAN, HOLLY L (LCSW)
Entity type:Individual
Prefix:MS
First Name:HOLLY
Middle Name:L
Last Name:THOMAS-CHAPMAN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3216 PICKETT RD
Mailing Address - Street 2:
Mailing Address - City:SAINT JOSEPH
Mailing Address - State:MO
Mailing Address - Zip Code:64503-1428
Mailing Address - Country:US
Mailing Address - Phone:816-294-0861
Mailing Address - Fax:
Practice Address - Street 1:3216 PICKETT RD
Practice Address - Street 2:
Practice Address - City:SAINT JOSEPH
Practice Address - State:MO
Practice Address - Zip Code:64503-1428
Practice Address - Country:US
Practice Address - Phone:816-294-0861
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-16
Last Update Date:2017-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20040050111041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO499099018Medicaid
MO33721028OtherBLUE CROSS BLUE SHIELD KC
MO499099000Medicaid
MO499099018Medicaid