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General NPI Number Information
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NPI Number | 1831247139
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Entity Type | Individual
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Provider Name | PHYLLIS D CHASE MA, MFT
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Gender | Female
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Dates
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Enumeration Date | 01/05/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 146 N ALMONT DR
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City | WEST HOLLYWOOD
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State | CA
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Zip | 90048-2957
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Country | US
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Telephone | 310-402-8888
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Fax |
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Provider Business Mailing Address
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Address Line | 311 N ROBERTSON BLVD 918
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City | BEVERLY HILLS
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State | CA
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Zip | 90211-1705
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Country | US
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Telephone | 310-402-8888
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Fax |
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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 | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 35263
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License Number State | CA
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