MEDICARE: ADRIAN VICENCIO CHAVIRA LPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	82583	TX

General Provider Information

NPI Number	:	1134707086
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ADRIAN VICENCIO CHAVIRA LPC

Provider Business Mailing Address
First Line	:	1605 GEORGE DIETER DR STE 635
Second Line	:
City	:	EL PASO
State	:	TX
Zip	:	79936-5692
Country	:	US
Telephone Number	:	915-671-1371
Fax Number	:	915-219-9022

Provider Business Practice Location Address
First Line	:	5625 WOODROW BEAN STE 133
Second Line	:
City	:	EL PASO
State	:	TX
Zip	:	79924-4144
Country	:	US
Telephone Number	:	915-588-0486
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/31/2021
Last Update Date	:	02/26/2025

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