Provider Demographics
NPI:1902968092
Name:CHASE, DORIS ETHYL (MA LMFT)
Entity Type:Individual
Prefix:MS
First Name:DORIS
Middle Name:ETHYL
Last Name:CHASE
Suffix:
Gender:F
Credentials:MA LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5805 CALLAGHAN
Mailing Address - Street 2:STE 100
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78228
Mailing Address - Country:US
Mailing Address - Phone:210-241-0530
Mailing Address - Fax:210-521-8561
Practice Address - Street 1:5805 CALLAGHAN
Practice Address - Street 2:STE. 100
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78228
Practice Address - Country:US
Practice Address - Phone:210-241-0530
Practice Address - Fax:210-521-4833
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-14
Last Update Date:2010-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX164345193106H00000X
TX163106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist