Provider Demographics
NPI:1346720711
Name:CHASE, NATHAN DAVID (LCPC, CADC)
Entity Type:Individual
Prefix:MR
First Name:NATHAN
Middle Name:DAVID
Last Name:CHASE
Suffix:
Gender:M
Credentials:LCPC, CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1101 W 40TH ST UNIT 2225
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37409-1379
Mailing Address - Country:US
Mailing Address - Phone:423-486-0774
Mailing Address - Fax:423-405-6346
Practice Address - Street 1:1312 SPRING CREEK RD
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37412-3918
Practice Address - Country:US
Practice Address - Phone:423-486-0774
Practice Address - Fax:423-405-6346
Is Sole Proprietor?:No
Enumeration Date:2018-08-15
Last Update Date:2023-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN5373101YP2500X
IL178012374101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ067716Medicaid