Provider Demographics
NPI:1578870325
Name:CHASE, LISSA M (MS)
Entity Type:Individual
Prefix:MS
First Name:LISSA
Middle Name:M
Last Name:CHASE
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16535 SW TV HWY
Mailing Address - Street 2:
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97006-5143
Mailing Address - Country:US
Mailing Address - Phone:503-259-3106
Mailing Address - Fax:503-649-7405
Practice Address - Street 1:16535 SW TV HWY
Practice Address - Street 2:
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97006-5143
Practice Address - Country:US
Practice Address - Phone:503-259-3106
Practice Address - Fax:503-649-7405
Is Sole Proprietor?:No
Enumeration Date:2010-08-31
Last Update Date:2010-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health