Provider Demographics
NPI:1386767960
Name:GERHART, CHAD L (PSYD)
Entity type:Individual
Prefix:DR
First Name:CHAD
Middle Name:L
Last Name:GERHART
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:714 S HIGHLAND AVE
Mailing Address - Street 2:
Mailing Address - City:JOPLIN
Mailing Address - State:MO
Mailing Address - Zip Code:64801-5209
Mailing Address - Country:US
Mailing Address - Phone:417-624-4475
Mailing Address - Fax:417-624-4540
Practice Address - Street 1:714 S HIGHLAND AVE
Practice Address - Street 2:
Practice Address - City:JOPLIN
Practice Address - State:MO
Practice Address - Zip Code:64801-5209
Practice Address - Country:US
Practice Address - Phone:417-624-4475
Practice Address - Fax:417-624-4540
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-09
Last Update Date:2020-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2006034114103TC0700X, 103TH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TH0100XBehavioral Health & Social Service ProvidersPsychologistHealth Service