Basic Information
| Provider Information | |||||||||
| NPI: | 1346720711 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CHASE | ||||||||
| FirstName: | NATHAN | ||||||||
| MiddleName: | DAVID | ||||||||
| NamePrefix: | MR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | LCPC, CADC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1101 W 40TH ST UNIT 2225 | ||||||||
| Address2: | |||||||||
| City: | CHATTANOOGA | ||||||||
| State: | TN | ||||||||
| PostalCode: | 374091379 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4234860774 | ||||||||
| FaxNumber: | 4234056346 | ||||||||
| Practice Location | |||||||||
| Address1: | 1312 SPRING CREEK RD | ||||||||
| Address2: | |||||||||
| City: | CHATTANOOGA | ||||||||
| State: | TN | ||||||||
| PostalCode: | 374123918 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4234860774 | ||||||||
| FaxNumber: | 4234056346 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/15/2018 | ||||||||
| LastUpdateDate: | 10/20/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/20/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YP2500X | 5373 | TN | N | Behavioral Health & Social Service Providers | Counselor | Professional | 101YP2500X | 178012374 | IL | Y | Behavioral Health & Social Service Providers | Counselor | Professional |
ID Information
| ID | Type | State | Issuer | Description | Q067716 | 05 | TN | MEDICAID |