Basic Information
| Provider Information | |||||||||
| NPI: | 1407096977 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CHASE | ||||||||
| FirstName: | LESIA | ||||||||
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| Credential: | CADCII | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1652 QUAILS NEST ST | ||||||||
| Address2: | |||||||||
| City: | ROSEVILLE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 957474633 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9162968165 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1965 LIVE OAK BLVD | ||||||||
| Address2: | |||||||||
| City: | YUBA CITY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 959918850 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5308227200 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/24/2009 | ||||||||
| LastUpdateDate: | 05/19/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 376K00000X | N | Nursing Service Related Providers | Nurse's Aide | 101YM0800X | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.