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NPI Code Detail

MEDICARE: DIANACHAVEZ, LLC

MEDICARE: DIANACHAVEZ, LLC
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
1261QM0801XMental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number : 1235756727
Entity Type Code : Organization
Provider Name (Legal Business Name) : DIANACHAVEZ, LLC
Provider Business Mailing Address
First Line : PO BOX 754
Second Line :
City : LAS VEGAS
State : NM
Zip : 87701-0754
Country : US
Telephone Number : 505-690-1171
Fax Number :
Provider Business Practice Location Address
First Line : 505 NATIONAL AVE STE 2
Second Line :
City : LAS VEGAS
State : NM
Zip : 87701-4353
Country : US
Telephone Number : 505-690-1171
Fax Number :
Authorized Official
Title or Position : COUNSELOR
Name : CARLA DIANA CHAVEZ
Credential : LPCC
Telephone Number : 505-690-1171
Provider Enumeration Date : 06/30/2020
Last Update Date : 06/16/2026

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