Provider Demographics
NPI:1710553755
Name:SORRELLS, CHASE OLIVIA
Entity Type:Individual
Prefix:
First Name:CHASE
Middle Name:OLIVIA
Last Name:SORRELLS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8035 ERL THORNTON FWY
Mailing Address - Street 2:251
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75228
Mailing Address - Country:US
Mailing Address - Phone:214-609-7775
Mailing Address - Fax:678-559-1605
Practice Address - Street 1:8035 ERL THORNTON FWY
Practice Address - Street 2:251
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75228
Practice Address - Country:US
Practice Address - Phone:214-609-7775
Practice Address - Fax:678-559-1605
Is Sole Proprietor?:No
Enumeration Date:2021-06-01
Last Update Date:2021-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX84281101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor