Provider Demographics
NPI:1588708226
Name:CHASE, TERRY JEAN (LMSW,LMHC,LMHP)
Entity type:Individual
Prefix:MRS
First Name:TERRY
Middle Name:JEAN
Last Name:CHASE
Suffix:
Gender:F
Credentials:LMSW,LMHC,LMHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:625 E 39TH ST
Mailing Address - Street 2:
Mailing Address - City:SOUTH SIOUX CITY
Mailing Address - State:NE
Mailing Address - Zip Code:68776-3445
Mailing Address - Country:US
Mailing Address - Phone:712-389-6412
Mailing Address - Fax:402-494-2735
Practice Address - Street 1:625 E 39TH ST
Practice Address - Street 2:
Practice Address - City:SOUTH SIOUX CITY
Practice Address - State:NE
Practice Address - Zip Code:68776-3445
Practice Address - Country:US
Practice Address - Phone:712-389-6412
Practice Address - Fax:402-494-2735
Is Sole Proprietor?:No
Enumeration Date:2007-02-16
Last Update Date:2011-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA001198101YM0800X
IA03175104100000X
NE3426101YM0800X
NE1729101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional