MEDICARE: AVERY 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	106S00000X	Behavior Technician

General Provider Information

NPI Number	:	1154118313
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AVERY CHASE

Provider Business Mailing Address
First Line	:	6805 COONIE CT
Second Line	:
City	:	WILLOW SPRING
State	:	NC
Zip	:	27592-7870
Country	:	US
Telephone Number	:	919-559-7702
Fax Number	:

Provider Business Practice Location Address
First Line	:	6805 COONIE CT
Second Line	:
City	:	WILLOW SPRING
State	:	NC
Zip	:	27592-7870
Country	:	US
Telephone Number	:	919-559-7702
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/22/2025
Last Update Date	:	04/22/2025

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Directions to “ AVERY CHASE ” Practice Location

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