Provider Demographics
NPI:1598732273
Name:WINE CHASE, GEORGE M (MDIV, MS)
Entity Type:Individual
Prefix:MR
First Name:GEORGE
Middle Name:M
Last Name:WINE CHASE
Suffix:
Gender:M
Credentials:MDIV, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9233 WARD PKWY
Mailing Address - Street 2:SUITE 305
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64114-3366
Mailing Address - Country:US
Mailing Address - Phone:816-824-9898
Mailing Address - Fax:816-527-8052
Practice Address - Street 1:9233 WARD PKWY
Practice Address - Street 2:SUITE 305
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64114-3366
Practice Address - Country:US
Practice Address - Phone:816-824-9898
Practice Address - Fax:816-527-8052
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-02
Last Update Date:2010-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2669101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO27215019OtherBCBS PROVIDER #
MOWINE CHASEOtherCOVENTRY/MHNET
MO48-1180532OtherUBH PROVIDER #
48118053264111B004OtherTRICARE
MOWINE CHASEOtherHUMANA/CHOICECARE/CORPHEALTH/LIFESYNCH
MOWINE CHASEOtherMULTIPLAN/PHCS
MO569447OtherVALUEOPTIONS
MO7968347OtherAETNA
MO2322864OtherCIGNA