NPIMap

Individual provider Active NPI

Terry Jean Chase, LMSW,LMHC,LMHP

  • Social Worker
  • South Sioux City, NE
National Provider Identifier
1588708226
Registry record updated Sep 15, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Social WorkerTaxonomy code 104100000X
License
03175 Issued in IA
Practice address
625 E 39TH St
South Sioux City, NE 68776-3445
Phone
(712) 389-6412
Fax
(402) 494-2735
NPI assigned
Feb 16, 2007
Last updated
Sep 15, 2011By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 15, 2011

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Counselor 101YM0800X 001198 IA
Mental Health Counselor 101YM0800X 3426 NE
Professional Counselor 101YP2500X 1729 NE
Social Worker 104100000X 03175 IA Primary

Addresses

Primary practice location

625 E 39TH St
South Sioux City, NE 68776-3445

Mailing address

625 E 39TH St
South Sioux City, NE 68776-3445
Phone (712) 389-6412

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
001198IAMDMental Health Counselor
3426NEMDMental Health Counselor
03175IAMDPhysical Therapist
1729NEMDMedical Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Family Wellness Associates, Inc. Past Accepting new patients

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1171584000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1316044800000",
    "number": "1588708226",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "625 E 39TH ST",
            "city": "SOUTH SIOUX CITY",
            "state": "NE",
            "postal_code": "687763445",
            "telephone_number": "712-389-6412",
            "fax_number": "402-494-2735"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "625 E 39TH ST",
            "city": "SOUTH SIOUX CITY",
            "state": "NE",
            "postal_code": "687763445",
            "telephone_number": "712-389-6412",
            "fax_number": "402-494-2735"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CHASE",
        "first_name": "TERRY",
        "middle_name": "JEAN",
        "name_prefix": "Mrs.",
        "credential": "LMSW,LMHC,LMHP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-02-16",
        "last_updated": "2011-09-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "IA",
            "license": "001198",
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "NE",
            "license": "3426",
            "primary": false
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "NE",
            "license": "1729",
            "primary": false
        },
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "IA",
            "license": "03175",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in South Sioux City, NE

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 15, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.