Provider Demographics
NPI:1578395976
Name:CHASE, COLETTE R
Entity type:Individual
Prefix:MS
First Name:COLETTE
Middle Name:R
Last Name:CHASE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5805 CALLAGHAN RD STE 206
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78228-1127
Mailing Address - Country:US
Mailing Address - Phone:210-842-1777
Mailing Address - Fax:210-579-5577
Practice Address - Street 1:5805 CALLAGHAN RD STE 206
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78228-1127
Practice Address - Country:US
Practice Address - Phone:210-842-1777
Practice Address - Fax:210-579-5577
Is Sole Proprietor?:No
Enumeration Date:2024-08-15
Last Update Date:2024-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX86516101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health