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NPI Code Detail

MEDICARE: MRS. TERRY JEAN CHASE LMSW,LMHC,LMHP

MEDICARE:  MRS. TERRY JEAN CHASE  LMSW,LMHC,LMHP
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
1101YM0800XMental Health Counselor001198IA
2104100000XSocial Worker03175IA
3101YM0800XMental Health Counselor3426NE
4101YP2500XProfessional Counselor1729NE

General Provider Information

NPI Number : 1588708226
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. TERRY JEAN CHASE LMSW,LMHC,LMHP
Provider Business Mailing Address
First Line : 625 E 39TH ST
Second Line :
City : SOUTH SIOUX CITY
State : NE
Zip : 68776-3445
Country : US
Telephone Number : 712-389-6412
Fax Number : 402-494-2735
Provider Business Practice Location Address
First Line : 625 E 39TH ST
Second Line :
City : SOUTH SIOUX CITY
State : NE
Zip : 68776-3445
Country : US
Telephone Number : 712-389-6412
Fax Number : 402-494-2735
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/16/2007
Last Update Date : 09/15/2011

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