Provider Demographics
NPI:1730774795
Name:CHASE, CHARLOTTE ANNE (PHD)
Entity type:Individual
Prefix:DR
First Name:CHARLOTTE
Middle Name:ANNE
Last Name:CHASE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 S HITCHING POST DR
Mailing Address - Street 2:
Mailing Address - City:CAMP VERDE
Mailing Address - State:AZ
Mailing Address - Zip Code:86322-4974
Mailing Address - Country:US
Mailing Address - Phone:928-567-8810
Mailing Address - Fax:
Practice Address - Street 1:500 S HITCHING POST DR
Practice Address - Street 2:
Practice Address - City:CAMP VERDE
Practice Address - State:AZ
Practice Address - Zip Code:86322-4974
Practice Address - Country:US
Practice Address - Phone:928-567-8810
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-02
Last Update Date:2021-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401010156101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional