MEDICARE: ALTA L CHASE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TP2701X	Group Psychotherapy Psychologist	61	NH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1083781199
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ALTA L CHASE

Provider Business Mailing Address
First Line	:	441 BOG ROAD
Second Line	:
City	:	STRATFORD
State	:	NH
Zip	:	03590
Country	:	US
Telephone Number	:	603-636-9914
Fax Number	:

Provider Business Practice Location Address
First Line	:	441 BOG ROAD
Second Line	:
City	:	STRATFORD
State	:	NH
Zip	:	03590
Country	:	US
Telephone Number	:	603-636-9914
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. ALTA L CHASE
Credential	:	D MIN
Telephone Number	:	603-636-9914

Provider Enumeration Date	:	11/30/2006
Last Update Date	:	04/30/2008

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Directions to “ALTA L CHASE ” Practice Location

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