Basic Information
| Provider Information | |||||||||
| NPI: | 1669915062 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CALLARD | ||||||||
| FirstName: | CHASE | ||||||||
| MiddleName: | HAMILTON | ||||||||
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| Credential: | BCBA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 270 N 200 W | ||||||||
| Address2: | APT 2 | ||||||||
| City: | LOGAN | ||||||||
| State: | UT | ||||||||
| PostalCode: | 843213806 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2487660015 | ||||||||
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| Practice Location | |||||||||
| Address1: | 11698 HURON ST | ||||||||
| Address2: | BUILDING 5, SUITE 106 | ||||||||
| City: | NORTHGLENN | ||||||||
| State: | CO | ||||||||
| PostalCode: | 802342920 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7203810264 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 12/02/2016 | ||||||||
| LastUpdateDate: | 12/02/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103K00000X | 1-14-15884 | UT | Y | Behavioral Health & Social Service Providers | Behavioral Analyst |
No ID Information.