Provider Demographics
NPI:1417639139
Name:YOGI, CHASE
Entity Type:Individual
Prefix:
First Name:CHASE
Middle Name:
Last Name:YOGI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:95-1158 MAKAIKAI ST APT 145
Mailing Address - Street 2:
Mailing Address - City:MILILANI
Mailing Address - State:HI
Mailing Address - Zip Code:96789-5347
Mailing Address - Country:US
Mailing Address - Phone:808-722-9594
Mailing Address - Fax:
Practice Address - Street 1:99-149 MOANALUA RD STE 201
Practice Address - Street 2:
Practice Address - City:AIEA
Practice Address - State:HI
Practice Address - Zip Code:96701-4001
Practice Address - Country:US
Practice Address - Phone:909-284-1823
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-02
Last Update Date:2023-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI852101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health