MEDICARE: CHASE C BUTALA CRC, LPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225C00000X	Rehabilitation Counselor
2	101YP2500X	Professional Counselor	0701006265	VA

General Provider Information

NPI Number	:	1215347687
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHASE C BUTALA CRC, LPC

Provider Business Mailing Address
First Line	:	7051 HEATHCOTE VILLAGE WAY STE 115
Second Line	:
City	:	GAINESVILLE
State	:	VA
Zip	:	20155-3197
Country	:	US
Telephone Number	:	804-207-6737
Fax Number	:

Provider Business Practice Location Address
First Line	:	7051 HEATHCOTE VILLAGE WAY STE 115
Second Line	:
City	:	GAINESVILLE
State	:	VA
Zip	:	20155-3197
Country	:	US
Telephone Number	:	804-207-6737
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/06/2014
Last Update Date	:	11/17/2023

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