Basic Information
| Provider Information | |||||||||
| NPI: | 1235803131 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CHMELA | ||||||||
| FirstName: | ROBIN | ||||||||
| MiddleName: | ELISABETH | ||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | LCSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1913 PARKTON WEST DR | ||||||||
| Address2: | |||||||||
| City: | BARNHART | ||||||||
| State: | MO | ||||||||
| PostalCode: | 630121240 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3142392409 | ||||||||
| FaxNumber: | 0000000000 | ||||||||
| Practice Location | |||||||||
| Address1: | 807 COLLINS DR | ||||||||
| Address2: | |||||||||
| City: | FESTUS | ||||||||
| State: | MO | ||||||||
| PostalCode: | 630282346 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6369314206 | ||||||||
| FaxNumber: | 6369315774 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/04/2021 | ||||||||
| LastUpdateDate: | 08/04/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/04/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 002605 | MO | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
ID Information
| ID | Type | State | Issuer | Description | 002605 | 05 | MO | MEDICAID |