Provider Demographics
NPI:1639293699
Name:CHASE, KATHY S (LCPC)
Entity Type:Individual
Prefix:MRS
First Name:KATHY
Middle Name:S
Last Name:CHASE
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:318 W HALF DAY RD
Mailing Address - Street 2:PMB 284
Mailing Address - City:BUFFALO GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60089-6547
Mailing Address - Country:US
Mailing Address - Phone:847-271-7504
Mailing Address - Fax:
Practice Address - Street 1:675 N NORTH CT
Practice Address - Street 2:
Practice Address - City:PALATINE
Practice Address - State:IL
Practice Address - Zip Code:60067-8157
Practice Address - Country:US
Practice Address - Phone:847-271-7504
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional