Healthcare Provider Details

I. General information

NPI: 1518598085
Provider Name (Legal Business Name): CHASE ARTHUR LONGNAKER MSC, MFT ASSOCIATE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/03/2020
Last Update Date: 11/27/2023
Certification Date: 02/03/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8106 RED STONE HILL RD
LOUISVILLE KY
40214-4614
US

IV. Provider business mailing address

1215 ORMSBY LN
LOUISVILLE KY
40222-3862
US

V. Phone/Fax

Practice location:
  • Phone: 502-257-5576
  • Fax: 833-953-0891
Mailing address:
  • Phone: 502-523-7863
  • Fax: 833-953-0891

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number173543
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: