Provider Demographics
NPI:1861057234
Name:CHASE, EILEEN ALEXANDRIA (MS, ESQ)
Entity type:Individual
Prefix:
First Name:EILEEN
Middle Name:ALEXANDRIA
Last Name:CHASE
Suffix:
Gender:F
Credentials:MS, ESQ
Other - Prefix:
Other - First Name:ANDREA
Other - Middle Name:
Other - Last Name:CHASE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MS, ESQ
Mailing Address - Street 1:391 BROAD ST NW # 201
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:TN
Mailing Address - Zip Code:37311-5039
Mailing Address - Country:US
Mailing Address - Phone:423-790-3747
Mailing Address - Fax:
Practice Address - Street 1:391 BROAD ST NW STE 201
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:TN
Practice Address - Zip Code:37311-5039
Practice Address - Country:US
Practice Address - Phone:423-790-3747
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-01
Last Update Date:2024-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN6474101YM0800X
101YM0800X, 101YS0200X, 172V00000X, 222Q00000X, 103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool
No172V00000XOther Service ProvidersCommunity Health Worker
No222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ022498Medicaid