Provider Demographics
NPI:1366804239
Name:CHASE, RICHARD BERTRAND III (LPC)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:BERTRAND
Last Name:CHASE
Suffix:III
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:115 CHRISTIAN LN
Mailing Address - Street 2:
Mailing Address - City:SLIDELL
Mailing Address - State:LA
Mailing Address - Zip Code:70458-1350
Mailing Address - Country:US
Mailing Address - Phone:985-690-6622
Mailing Address - Fax:856-906-6622
Practice Address - Street 1:115 CHRISTIAN LN
Practice Address - Street 2:
Practice Address - City:SLIDELL
Practice Address - State:LA
Practice Address - Zip Code:70458-1350
Practice Address - Country:US
Practice Address - Phone:985-690-6622
Practice Address - Fax:985-690-6662
Is Sole Proprietor?:No
Enumeration Date:2016-03-22
Last Update Date:2024-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY175247101YP2500X
LA9931101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional