Provider Demographics
NPI:1679253389
Name:CHASE, ALISSA (LPC)
Entity Type:Individual
Prefix:
First Name:ALISSA
Middle Name:
Last Name:CHASE
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19847 W BLUE HORIZONS CT
Mailing Address - Street 2:
Mailing Address - City:BUCKEYE
Mailing Address - State:AZ
Mailing Address - Zip Code:85326-5095
Mailing Address - Country:US
Mailing Address - Phone:623-205-4470
Mailing Address - Fax:
Practice Address - Street 1:19847 W BLUE HORIZONS CT
Practice Address - Street 2:
Practice Address - City:BUCKEYE
Practice Address - State:AZ
Practice Address - Zip Code:85326-5095
Practice Address - Country:US
Practice Address - Phone:623-205-4470
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-19
Last Update Date:2023-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLPC-19744101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional