Provider Demographics
NPI:1215080320
Name:CHARTRAND, JANET S (RN, LCSW LPC, NCC)
Entity type:Individual
Prefix:MS
First Name:JANET
Middle Name:S
Last Name:CHARTRAND
Suffix:
Gender:F
Credentials:RN, LCSW LPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8361 ARDSLEY DR
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63121-4524
Mailing Address - Country:US
Mailing Address - Phone:314-318-1387
Mailing Address - Fax:
Practice Address - Street 1:4132 KEATON CROSSING BLVD
Practice Address - Street 2:SUITE 201
Practice Address - City:O FALLON
Practice Address - State:MO
Practice Address - Zip Code:63368-8222
Practice Address - Country:US
Practice Address - Phone:636-244-3589
Practice Address - Fax:636-244-3594
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-19
Last Update Date:2012-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO002402101YM0800X
MO0026521041C0700X
MO066948163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO000078496Medicare ID - Type Unspecified