Provider Demographics
NPI:1942957493
Name:GRIFFIN, CHASE (LCSW)
Entity type:Individual
Prefix:
First Name:CHASE
Middle Name:
Last Name:GRIFFIN
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:505 W UNIVERSITY AVE STE 202-203
Mailing Address - Street 2:
Mailing Address - City:CHAMPAIGN
Mailing Address - State:IL
Mailing Address - Zip Code:61820-3915
Mailing Address - Country:US
Mailing Address - Phone:224-232-8057
Mailing Address - Fax:217-689-1666
Practice Address - Street 1:313 N MATTIS AVE STE 116
Practice Address - Street 2:
Practice Address - City:CHAMPAIGN
Practice Address - State:IL
Practice Address - Zip Code:61821-7900
Practice Address - Country:US
Practice Address - Phone:224-232-8057
Practice Address - Fax:172-888-2744
Is Sole Proprietor?:No
Enumeration Date:2022-03-04
Last Update Date:2025-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL150.106636104100000X
IL1490292991041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker