1194530212 NPI number — CHELSEA RANA GORD COUNSELOR INTERN

Table of content: CHELSEA RANA GORD COUNSELOR INTERN (NPI 1194530212)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1194530212 NPI number — CHELSEA RANA GORD COUNSELOR INTERN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GORD
Provider First Name:
CHELSEA
Provider Middle Name:
RANA
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
COUNSELOR INTERN
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1194530212
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/07/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3 BRIAR CT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MOSCOW MILLS
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
63362-2442
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
539 N GRAND BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAINT LOUIS
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
63103-1026
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
314-652-3623
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/07/2025

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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