Provider Demographics
NPI:1003805078
Name:CHASE, GARY H (PHD PSYCHOLOGIST)
Entity Type:Individual
Prefix:DR
First Name:GARY
Middle Name:H
Last Name:CHASE
Suffix:
Gender:M
Credentials:PHD PSYCHOLOGIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6136 FRISCO SQUARE BLVD
Mailing Address - Street 2:SUITE 400
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75034-3246
Mailing Address - Country:US
Mailing Address - Phone:469-362-3334
Mailing Address - Fax:972-334-0347
Practice Address - Street 1:6136 FRISCO SQUARE BLVD
Practice Address - Street 2:SUITE 400
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75034-3246
Practice Address - Country:US
Practice Address - Phone:469-362-3334
Practice Address - Fax:972-334-0347
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX32373103T00000X, 103TC0700X, 103TH0100X, 103TC1900X, 103TF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103T00000XBehavioral Health & Social Service ProvidersPsychologist
Not Answered103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Not Answered103TH0100XBehavioral Health & Social Service ProvidersPsychologistHealth Service
Not Answered103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
Not Answered103TF0000XBehavioral Health & Social Service ProvidersPsychologistFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0024LVOtherBCBS
7539799OtherAETNA
80314OtherUNICARE
063003OtherVALUE OPTIONS
217437OtherMANAGED HEALTH NETWORK
TX612244Medicare ID - Type Unspecified