Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103G00000X | Clinical Psychologist | 2006034114 | MO |
Y | 103TC0700X | Clinical Psychologist | 2006034114 | MO |
N | 103TH0100X | Health Service | 2006034114 | MO |
NPI | 1386767960 |
---|---|
Provider Name | Dr. Chad L Gerhart |
First Address | Joplin, MO 64801-5209 |
Second Address | Joplin, MO 64801-5209 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/04/2007 |
Last Update Date | 14/09/2020 |