Provider Demographics
NPI:1538646583
Name:VALENCIANO, CHASE G (LCSW)
Entity Type:Individual
Prefix:
First Name:CHASE
Middle Name:G
Last Name:VALENCIANO
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:621 S 6TH AVE
Mailing Address - Street 2:
Mailing Address - City:EDINBURG
Mailing Address - State:TX
Mailing Address - Zip Code:78539-4208
Mailing Address - Country:US
Mailing Address - Phone:956-342-3466
Mailing Address - Fax:
Practice Address - Street 1:621 S 6TH AVE
Practice Address - Street 2:
Practice Address - City:EDINBURG
Practice Address - State:TX
Practice Address - Zip Code:78539-4208
Practice Address - Country:US
Practice Address - Phone:956-342-3466
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-23
Last Update Date:2021-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX606701041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX737613OtherTX- MEDICARE
TX388328202Medicaid