NPIMap

Justin N Chase, LAC

Individual provider Active NPI Addiction (Substance Use Disorder) Counselor · Fargo, ND

NPI 1831753631 · NPPES record last updated Apr 26, 2019

Key facts

NPI
1831753631
Entity type
Individual (NPI type 1)
Primary specialty
Addiction (Substance Use Disorder) Counselor 101YA0400X
License
1851 (ND)
Practice address
2701 12TH Ave S
Fargo, ND 58103-8753
Phone
(701) 451-4900
NPI assigned
Apr 26, 2019
Sex
Male
Sole proprietor
No

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 and National Provider Directory roles.

Medicare participation

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

National Provider Directory

Medicare enrollment (NPD)
No

State licenses

LicenseStateTypeSpecialty
1851NDMDAddiction (Substance Use Disorder) Counselor

Practice roles

OrganizationSpecialtyStatusNew patients
Village Family Service Center Addiction (Substance Use Disorder) Past Accepting new patients

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Addiction (Substance Use Disorder) Counselor 101YA0400X 1851 ND Yes

Addresses

Primary practice location

2701 12TH Ave S
Fargo, ND 58103-8753

Mailing address

1201 25TH St S
Fargo, ND 58103-2311
Phone (701) 451-4900

Other providers in Fargo, ND

All providers in Fargo, ND · Addiction (Substance Use Disorder) Counselor in North Dakota

Sources for this page

Verify at the official NPI Registry.