Provider Demographics
NPI:1760190128
Name:CHASE, VANESSA LYNN (LMHC)
Entity Type:Individual
Prefix:
First Name:VANESSA
Middle Name:LYNN
Last Name:CHASE
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 206
Mailing Address - Street 2:
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:IA
Mailing Address - Zip Code:50630-0206
Mailing Address - Country:US
Mailing Address - Phone:563-237-5300
Mailing Address - Fax:563-237-5304
Practice Address - Street 1:602 S WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:FREDERICKSBURG
Practice Address - State:IA
Practice Address - Zip Code:50630-1003
Practice Address - Country:US
Practice Address - Phone:563-237-5300
Practice Address - Fax:563-237-5304
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-14
Last Update Date:2022-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA099562101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health