Provider Demographics
NPI:1104378603
Name:CHASE, CHRISTI LYNN (LMSW)
Entity Type:Individual
Prefix:
First Name:CHRISTI
Middle Name:LYNN
Last Name:CHASE
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1010 15TH AVE
Mailing Address - Street 2:
Mailing Address - City:LEWISTON
Mailing Address - State:ID
Mailing Address - Zip Code:83501-3726
Mailing Address - Country:US
Mailing Address - Phone:208-743-8101
Mailing Address - Fax:208-746-7402
Practice Address - Street 1:1014 MAIN ST
Practice Address - Street 2:
Practice Address - City:LEWISTON
Practice Address - State:ID
Practice Address - Zip Code:83501-1842
Practice Address - Country:US
Practice Address - Phone:208-743-8101
Practice Address - Fax:208-746-7402
Is Sole Proprietor?:No
Enumeration Date:2016-10-31
Last Update Date:2016-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLMSW36090104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker