Basic Information
| Provider Information | |||||||||
| NPI: | 1003805078 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CHASE | ||||||||
| FirstName: | GARY | ||||||||
| MiddleName: | H. | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | PH.D. PSYCHOLOGIST | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6136 FRISCO SQUARE BLVD | ||||||||
| Address2: | SUITE 400 | ||||||||
| City: | FRISCO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 750343246 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4693623334 | ||||||||
| FaxNumber: | 9723340347 | ||||||||
| Practice Location | |||||||||
| Address1: | 6136 FRISCO SQUARE BLVD | ||||||||
| Address2: | SUITE 400 | ||||||||
| City: | FRISCO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 750343246 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4693623334 | ||||||||
| FaxNumber: | 9723340347 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/20/2005 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103T00000X | 32373 | TX | X | Behavioral Health & Social Service Providers | Psychologist | 103TC0700X | 32373 | TX | X | Behavioral Health & Social Service Providers | Psychologist | Clinical | 103TH0100X | 32373 | TX | X | Behavioral Health & Social Service Providers | Psychologist | Health Service | 103TC1900X | 32373 | TX | X | Behavioral Health & Social Service Providers | Psychologist | Counseling | 103TF0000X | 32373 | TX | X | Behavioral Health & Social Service Providers | Psychologist | Family |
ID Information
| ID | Type | State | Issuer | Description | 0024LV | 01 | TX | BCBS | OTHER | 7539799 | 01 | AETNA | OTHER | 80314 | 01 | UNICARE | OTHER | 063003 | 01 | VALUE OPTIONS | OTHER | 217437 | 01 | MANAGED HEALTH NETWORK | OTHER |