Provider Demographics
NPI:1437615341
Name:JONES, CHASITY OCTAVIA (LPC, CD)
Entity type:Individual
Prefix:MS
First Name:CHASITY
Middle Name:OCTAVIA
Last Name:JONES
Suffix:
Gender:F
Credentials:LPC, CD
Other - Prefix:
Other - First Name:CHAS
Other - Middle Name:O
Other - Last Name:JONES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LPC, CD
Mailing Address - Street 1:1001 LYNCH ST
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63118-1818
Mailing Address - Country:US
Mailing Address - Phone:314-375-6531
Mailing Address - Fax:
Practice Address - Street 1:1001 LYNCH ST
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63118-1818
Practice Address - Country:US
Practice Address - Phone:314-375-6531
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-15
Last Update Date:2024-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO374J00000X
MO2019002714101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No374J00000XNursing Service Related ProvidersDoula
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO2019002714Medicaid