MEDICARE: CHUCK STAATS LCSW

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	1041C0700X	Clinical Social Worker	S06187	TX

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
2	123721	OTHER	TX	SUPERIOR
3	00558M	OTHER	TX	BLUE CROSS BLUE SHIELD
4	125047	OTHER	TX	MHN MANAGED HEALTH NETWOR
5	5241400	OTHER	TX	AETNA BEHAVIORAL HEALTH

General Provider Information

NPI Number	:	1629077995
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHUCK STAATS LCSW

Provider Business Mailing Address
First Line	:	1808 ROSE ST
Second Line	:
City	:	WICHITA FALLS
State	:	TX
Zip	:	76301-4219
Country	:	US
Telephone Number	:	940-723-4488
Fax Number	:	940-723-0446

Provider Business Practice Location Address
First Line	:	1808 ROSE ST
Second Line	:
City	:	WICHITA FALLS
State	:	TX
Zip	:	76301-4219
Country	:	US
Telephone Number	:	940-723-4488
Fax Number	:	940-723-0446

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

Provider Enumeration Date	:	07/19/2005
Last Update Date	:	10/09/2012

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Directions to “ CHUCK STAATS LCSW” Practice Location

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