| Doctor Name: | MR. CODY CHARLES CHASE |
| NPI Number: | 1487957106 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | MSW |
| License Number: | |
| Business Practice Address: | 290 Willamette St Umatilla, OR - 978826601 |
| Business Phone Number: | 5419226226 |
| Business Fax Number: | |
| Mailing Address: | 1911 W 6th, KENNEWIDK |
| State: | WA |
| Postal Code: | 99336 |
| Phone Number: | 5419226226 |
| Fax Number: | |
| NPI Enumeration Date: | 12/20/2010 |
| NPI Last Update Date: | 12/20/2010 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YM0800X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Mental Health |
| Taxonomy Definition: | |