Provider Demographics
NPI:1427462373
Name:QUEEN, CHASE PATRICK (LICDC-CS; LPC-S; LSW)
Entity type:Individual
Prefix:MR
First Name:CHASE
Middle Name:PATRICK
Last Name:QUEEN
Suffix:
Gender:M
Credentials:LICDC-CS; LPC-S; LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16149 STATE ROUTE 104
Mailing Address - Street 2:
Mailing Address - City:CHILLICOTHE
Mailing Address - State:OH
Mailing Address - Zip Code:45601-9701
Mailing Address - Country:US
Mailing Address - Phone:740-701-2103
Mailing Address - Fax:
Practice Address - Street 1:16149 STATE ROUTE 104
Practice Address - Street 2:
Practice Address - City:CHILLICOTHE
Practice Address - State:OH
Practice Address - Zip Code:45601-9701
Practice Address - Country:US
Practice Address - Phone:740-701-2103
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-19
Last Update Date:2014-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH991715101YA0400X
OHC-0006302101YP2500X
OHS-0015211104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No104100000XBehavioral Health & Social Service ProvidersSocial Worker