Provider Demographics
NPI:1265145478
Name:CHASTEEN, JAMES FOREST JR
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:FOREST
Last Name:CHASTEEN
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1506 SKYLINE DR
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:NE
Mailing Address - Zip Code:68701-2665
Mailing Address - Country:US
Mailing Address - Phone:402-750-1115
Mailing Address - Fax:
Practice Address - Street 1:1506 SKYLINE DR
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:NE
Practice Address - Zip Code:68701-2665
Practice Address - Country:US
Practice Address - Phone:402-750-1115
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-03
Last Update Date:2023-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician