Active NPI
David Andrew Chism, LPC
- Mental Health Counselor
- Kirkwood, MO
National Provider Identifier
1730757485
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- License
- 2021001879
- Practice address
- 111 Prospect Avenue
Suite 203, Room a
Kirkwood, MO 63122-6067 - Phone
- (314) 591-0273
- NPI assigned
- Jun 17, 2021
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | 2021001879 | MO | Primary |
Addresses
Primary practice location
111 Prospect Avenue
Suite 203, Room a
Kirkwood, MO 63122-6067
Mailing address
111 Prospect Avenue
Suite 203, Room a
Kirkwood, MO 63122-6067
Phone (314) 591-0273
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Feb 24, 2024 through Feb 24, 2028
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2021001879 | MO | MD | Mental Health Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1623888000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1716508800000",
"number": "1730757485",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "111 PROSPECT AVENUE",
"address_2": "SUITE 203, ROOM A",
"city": "KIRKWOOD",
"state": "MO",
"postal_code": "631226067",
"telephone_number": "314-591-0273"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "111 PROSPECT AVENUE",
"address_2": "SUITE 203, ROOM A",
"city": "KIRKWOOD",
"state": "MO",
"postal_code": "631226067",
"telephone_number": "314-591-0273"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CHISM",
"first_name": "DAVID",
"middle_name": "ANDREW",
"credential": "LPC",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2021-06-17",
"last_updated": "2024-05-24",
"certification_date": "2024-05-24",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "MO",
"license": "2021001879",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Kirkwood, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 24, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.