MEDICARE: DR. CHARLOTTE ANNE CHASE PHD

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	101YP2500X	Professional Counselor	6401010156	MI

General Provider Information

NPI Number	:	1730774795
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CHARLOTTE ANNE CHASE PHD

Provider Business Mailing Address
First Line	:	500 S HITCHING POST DR
Second Line	:
City	:	CAMP VERDE
State	:	AZ
Zip	:	86322-4974
Country	:	US
Telephone Number	:	928-567-8810
Fax Number	:

Provider Business Practice Location Address
First Line	:	500 S HITCHING POST DR
Second Line	:
City	:	CAMP VERDE
State	:	AZ
Zip	:	86322-4974
Country	:	US
Telephone Number	:	928-567-8810
Fax Number	:

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

Provider Enumeration Date	:	03/02/2021
Last Update Date	:	03/02/2021

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