Healthcare Provider Details

I. General information

NPI: 1336694777
Provider Name (Legal Business Name): TARYN CHASE MA, LPC, LCADC, NCC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/15/2016
Last Update Date: 07/27/2021
Certification Date: 07/27/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 SCOTCH RD STE E
EWING NJ
08628-2529
US

IV. Provider business mailing address

20 SCOTCH RD STE E
EWING NJ
08628-2529
US

V. Phone/Fax

Practice location:
  • Phone: 609-403-6359
  • Fax: 609-403-9488
Mailing address:
  • Phone: 609-403-6359
  • Fax: 609-403-9488

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number37LC00304100
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number37PC00644000
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: