Basic Information
Provider Information | |||||||||
NPI: | 1811286131 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | STRINGAM | ||||||||
FirstName: | CHASE | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | LCSW | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 1363 FILLMORE ST | ||||||||
Address2: |   | ||||||||
City: | TWIN FALLS | ||||||||
State: | ID | ||||||||
PostalCode: | 833013392 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 2087367090 | ||||||||
FaxNumber: | 2087367089 | ||||||||
Practice Location | |||||||||
Address1: | 1363 FILLMORE ST | ||||||||
Address2: |   | ||||||||
City: | TWIN FALLS | ||||||||
State: | ID | ||||||||
PostalCode: | 833013392 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 2087367090 | ||||||||
FaxNumber: | 2087367089 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 04/07/2011 | ||||||||
LastUpdateDate: | 08/19/2015 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | M | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X |   |   | N |   | Student, Health Care | Student in an Organized Health Care Education/Training Program |   | 1041C0700X | PCSW-512 | WY | N |   | Behavioral Health & Social Service Providers | Social Worker | Clinical | 1041C0700X | LMSW-33546 | ID | N |   | Behavioral Health & Social Service Providers | Social Worker | Clinical | 1041C0700X | LCSW-34084 | ID | Y |   | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.