Provider Demographics
NPI:1457422917
Name:CHASTAIN, JOHN JASON (LICSW)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:JASON
Last Name:CHASTAIN
Suffix:
Gender:M
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9825 SANDIFUR PKWY STE D
Mailing Address - Street 2:
Mailing Address - City:PASCO
Mailing Address - State:WA
Mailing Address - Zip Code:99301-6738
Mailing Address - Country:US
Mailing Address - Phone:509-531-6698
Mailing Address - Fax:509-402-1176
Practice Address - Street 1:9825 SANDIFUR PKWY STE D
Practice Address - Street 2:
Practice Address - City:PASCO
Practice Address - State:WA
Practice Address - Zip Code:99301-6738
Practice Address - Country:US
Practice Address - Phone:509-531-6698
Practice Address - Fax:509-402-1176
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-13
Last Update Date:2023-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALW604809771041C0700X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ004659Medicaid