Provider Demographics
NPI:1154538676
Name:CHASE, THEODORE PHILLIP (PMHNP)
Entity type:Individual
Prefix:MR
First Name:THEODORE
Middle Name:PHILLIP
Last Name:CHASE
Suffix:
Gender:M
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1902 SW 45TH ST
Mailing Address - Street 2:
Mailing Address - City:PENDLETON
Mailing Address - State:OR
Mailing Address - Zip Code:97801-4251
Mailing Address - Country:US
Mailing Address - Phone:541-276-9680
Mailing Address - Fax:
Practice Address - Street 1:2500 WESTGATE
Practice Address - Street 2:
Practice Address - City:PENDLETON
Practice Address - State:OR
Practice Address - Zip Code:97801-9606
Practice Address - Country:US
Practice Address - Phone:541-278-7128
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health