Basic Information
| Provider Information | |||||||||
| NPI: | 1174988109 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CHASE | ||||||||
| FirstName: | SUSAN | ||||||||
| MiddleName: | MARIE | ||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | LCSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3320 PETERSON RD FAMILY PSYCHOLOGICAL SERVICES LLC | ||||||||
| Address2: | SUITE 104 | ||||||||
| City: | LAWRENCE | ||||||||
| State: | KS | ||||||||
| PostalCode: | 66049 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7853711414 | ||||||||
| FaxNumber: | 7853714519 | ||||||||
| Practice Location | |||||||||
| Address1: | 3320 PETERSON RD FAMILY PSYCHOLOGICAL SERVICES LLC | ||||||||
| Address2: | SUITE 104 | ||||||||
| City: | LAWRENCE | ||||||||
| State: | KS | ||||||||
| PostalCode: | 66049 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7853711414 | ||||||||
| FaxNumber: | 7853714519 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/17/2015 | ||||||||
| LastUpdateDate: | 08/04/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/04/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 104100000X | 9637 | KS | Y | Behavioral Health & Social Service Providers | Social Worker |
No ID Information.