Doctor Name: | JIMMIE CHARLES CHASE |
NPI Number: | 1003025297 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | BS,CADC |
License Number: | 166 |
Business Practice Address: | 622 Se Frank Phillips Blvd Bartlesville, OK - 740033917 |
Business Phone Number: | 9183364646 |
Business Fax Number: | 9183368710 |
Mailing Address: | 205 S Santa Fe Elgin, SEDAN |
State: | KS |
Postal Code: | 673618526 |
Phone Number: | 6203462356 |
Fax Number: | |
NPI Enumeration Date: | 05/22/2007 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YA0400X |
License Number: | 166 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | OK |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Addiction (Substance Use Disorder) |
Taxonomy Definition: |