Provider Demographics
NPI:1669915062
Name:CALLARD, CHASE HAMILTON (BCBA)
Entity type:Individual
Prefix:
First Name:CHASE
Middle Name:HAMILTON
Last Name:CALLARD
Suffix:
Gender:M
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:270 N 200 W
Mailing Address - Street 2:APT 2
Mailing Address - City:LOGAN
Mailing Address - State:UT
Mailing Address - Zip Code:84321-3806
Mailing Address - Country:US
Mailing Address - Phone:248-766-0015
Mailing Address - Fax:
Practice Address - Street 1:11698 HURON ST
Practice Address - Street 2:BUILDING 5, SUITE 106
Practice Address - City:NORTHGLENN
Practice Address - State:CO
Practice Address - Zip Code:80234-2920
Practice Address - Country:US
Practice Address - Phone:720-381-0264
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-12-02
Last Update Date:2016-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT1-14-15884103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst