Provider Demographics
NPI:1104277821
Name:WALLING, CHASE (MA, LPC)
Entity type:Individual
Prefix:MR
First Name:CHASE
Middle Name:
Last Name:WALLING
Suffix:
Gender:M
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4310 RYAN ST.
Mailing Address - Street 2:SUITE 134
Mailing Address - City:LAKE CHARLES
Mailing Address - State:LA
Mailing Address - Zip Code:70605-4514
Mailing Address - Country:US
Mailing Address - Phone:337-943-0511
Mailing Address - Fax:337-508-2702
Practice Address - Street 1:1409 KIRKMAN ST
Practice Address - Street 2:
Practice Address - City:LAKE CHARLES
Practice Address - State:LA
Practice Address - Zip Code:70601-5344
Practice Address - Country:US
Practice Address - Phone:337-419-3586
Practice Address - Fax:855-239-9737
Is Sole Proprietor?:No
Enumeration Date:2016-06-23
Last Update Date:2021-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAPLPC #6799101YP2500X
101YM0800X
LA6799101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health