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General NPI Number Information
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NPI Number | 1104277821
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Entity Type | Individual
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Provider Name | CHASE WALLING M.A., LPC
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Gender | Male
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Dates
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Enumeration Date | 06/23/2016
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Last Update Date | 08/10/2021
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Provider Practice Location Address
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Address Line | 1409 KIRKMAN ST
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City | LAKE CHARLES
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State | LA
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Zip | 70601-5344
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Country | US
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Telephone | 337-419-3586
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Fax | 855-239-9737
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Provider Business Mailing Address
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Address Line | 4310 RYAN ST. SUITE 134
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City | LAKE CHARLES
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State | LA
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Zip | 70605-4514
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Country | US
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Telephone | 337-943-0511
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Fax | 337-508-2702
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | PLPC #6799
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License Number State | LA
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 6799
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License Number State | LA
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