Organization
ELEPHANT ROCK COUNSELING, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CHAD R RANDALL M.ED., LPC, CCDP-D (OWNER/THERAPIST)
(314) 200-4482
Entity
Organization
Contact information
Practice address
140 PROSPECT AVE STE T, KIRKWOOD, MO 63122-6024
(314) 200-4482
Mailing address
140 PROSPECT AVE STE T, KIRKWOOD, MO 63122-6024
(314) 200-4482
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
—
—
101YA0400X
Addiction (Substance Use Disorder) Counselor
—
—
101YM0800X
Mental Health Counselor
Primary
—
—
Other
Enumeration date
11/10/2020
Last updated
11/11/2020
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