Individual
MR. GEORGE M WINE CHASE
Active
Individual
MR. GEORGE M WINE CHASE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.DIV., M.S.
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
2669
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2322864
CIGNA
MO
01
—
27215019
BCBS PROVIDER #
MO
01
—
48-1180532
UBH PROVIDER #
MO
01
—
48118053264111B004
TRICARE
—
01
—
569447
VALUEOPTIONS
MO
01
—
7968347
AETNA
MO
01
—
WINE CHASE
COVENTRY/MHNET
MO
Enumeration date
03/02/2006
Last updated
11/02/2010
Update your record
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