Provider Demographics
NPI:1316624737
Name:JOHNSON, CHASE (LMSW)
Entity type:Individual
Prefix:
First Name:CHASE
Middle Name:
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 S 2ND ST STE A
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:MO
Mailing Address - Zip Code:64735-2172
Mailing Address - Country:US
Mailing Address - Phone:660-885-2394
Mailing Address - Fax:660-383-1650
Practice Address - Street 1:1800 W IRISH LN
Practice Address - Street 2:
Practice Address - City:KNOB NOSTER
Practice Address - State:MO
Practice Address - Zip Code:65336-1020
Practice Address - Country:US
Practice Address - Phone:660-687-0187
Practice Address - Fax:660-687-0221
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-28
Last Update Date:2023-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2022012321104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker