MEDICARE: ELLON CHASE 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	101YP2500X	Professional Counselor	2571394	ID

General Provider Information

NPI Number	:	1578495727
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELLON CHASE LPC

Provider Business Mailing Address
First Line	:	420 S CUTLER AVE
Second Line	:
City	:	SUGAR CITY
State	:	ID
Zip	:	83448-1142
Country	:	US
Telephone Number	:	208-351-6580
Fax Number	:

Provider Business Practice Location Address
First Line	:	420 S CUTLER AVE
Second Line	:
City	:	SUGAR CITY
State	:	ID
Zip	:	83448-1142
Country	:	US
Telephone Number	:	208-351-6580
Fax Number	:

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

Provider Enumeration Date	:	06/02/2026
Last Update Date	:	06/02/2026

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Directions to “ ELLON CHASE LPC” Practice Location

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