Provider Demographics
NPI:1740785591
Name:CHASE, ALICE G (LMHC)
Entity Type:Individual
Prefix:
First Name:ALICE
Middle Name:G
Last Name:CHASE
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:30689 PARROT REEF CT
Mailing Address - Street 2:
Mailing Address - City:WESLEY CHAPEL
Mailing Address - State:FL
Mailing Address - Zip Code:33545-5178
Mailing Address - Country:US
Mailing Address - Phone:802-578-0096
Mailing Address - Fax:813-436-5378
Practice Address - Street 1:1854 OAK GROVE BLVD
Practice Address - Street 2:
Practice Address - City:LUTZ
Practice Address - State:FL
Practice Address - Zip Code:33559-8605
Practice Address - Country:US
Practice Address - Phone:813-347-2735
Practice Address - Fax:813-948-3460
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-26
Last Update Date:2021-03-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FL15837101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health