Healthcare Provider Details

I. General information

NPI: 1437781911
Provider Name (Legal Business Name): CHASE ROWETON M.S., LAC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/12/2020
Last Update Date: 09/21/2026
Certification Date: 09/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 W NORTH ST APT E6
FAYETTEVILLE AR
72701-1964
US

IV. Provider business mailing address

600 W NORTH ST APT E6
FAYETTEVILLE AR
72701-1964
US

V. Phone/Fax

Practice location:
  • Phone: 417-298-5316
  • Fax:
Mailing address:
  • Phone: 417-298-5316
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberA2308018
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: