Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TB0200X | Cognitive & Behavioral Psychologist | 2006027463 | MO |
NPI | 1245393081 |
---|---|
Provider Name | Dr. Laura M. Chackes-Tonopolsky |
First Address | Creve Coeur, MO 63141-7760 |
Second Address | Creve Coeur, MO 63141-7760 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/12/2006 |
Last Update Date | 19/01/2017 |