Provider Demographics
NPI:1083781199
Name:ALTA L CHASE
Entity Type:Organization
Organization Name:ALTA L CHASE
Other - Org Name:STRATFORD COUNSELING CENTER
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ALTA
Authorized Official - Middle Name:L
Authorized Official - Last Name:CHASE
Authorized Official - Suffix:
Authorized Official - Credentials:D MIN
Authorized Official - Phone:603-636-9914
Mailing Address - Street 1:441 BOG ROAD
Mailing Address - Street 2:
Mailing Address - City:STRATFORD
Mailing Address - State:NH
Mailing Address - Zip Code:03590
Mailing Address - Country:US
Mailing Address - Phone:603-636-9914
Mailing Address - Fax:
Practice Address - Street 1:441 BOG ROAD
Practice Address - Street 2:
Practice Address - City:STRATFORD
Practice Address - State:NH
Practice Address - Zip Code:03590
Practice Address - Country:US
Practice Address - Phone:603-636-9914
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-30
Last Update Date:2008-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH61103TP2701X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TP2701XBehavioral Health & Social Service ProvidersPsychologistGroup PsychotherapyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30421051Medicaid