Provider Demographics
NPI:1346803970
Name:CHASE, HEATHER L (LPC)
Entity Type:Individual
Prefix:MS
First Name:HEATHER
Middle Name:L
Last Name:CHASE
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1050 SUNNYVIEW RD NE
Mailing Address - Street 2:#8276
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97303
Mailing Address - Country:US
Mailing Address - Phone:360-774-6067
Mailing Address - Fax:
Practice Address - Street 1:1595 ROOSEVELT ST NE
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97301
Practice Address - Country:US
Practice Address - Phone:360-774-6067
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-18
Last Update Date:2023-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500762125Medicaid