Healthcare Provider Details

I. General information

NPI: 1306230263
Provider Name (Legal Business Name): TERRI CHASE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/27/2015
Last Update Date: 04/09/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

784 HIGH ST
SAN LUIS OBISPO CA
93401-5243
US

IV. Provider business mailing address

1370 VIA DEL CARMEL
SANTA MARIA CA
93455-5655
US

V. Phone/Fax

Practice location:
  • Phone: 805-614-4940
  • Fax:
Mailing address:
  • Phone: 805-248-2995
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: