Provider Demographics
NPI:1083954572
Name:CHASE, CAROL LYNN (CADC)
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:LYNN
Last Name:CHASE
Suffix:
Gender:F
Credentials:CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOC 1710
Mailing Address - Street 2:
Mailing Address - City:REDMOND
Mailing Address - State:OR
Mailing Address - Zip Code:97756-0000
Mailing Address - Country:US
Mailing Address - Phone:541-516-4087
Mailing Address - Fax:541-516-4087
Practice Address - Street 1:2555 MAIN STREET
Practice Address - Street 2:
Practice Address - City:KLAMATH FALLS
Practice Address - State:OR
Practice Address - Zip Code:97603-0000
Practice Address - Country:US
Practice Address - Phone:541-516-4087
Practice Address - Fax:540-504-1195
Is Sole Proprietor?:No
Enumeration Date:2013-02-21
Last Update Date:2013-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR100905101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)