MEDICARE: CHAIDEZ COUNSELING SERVICES PLLC

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	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1801750815
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHAIDEZ COUNSELING SERVICES PLLC

Provider Business Mailing Address
First Line	:	2220 SAN JACINTO BLVD # 235G
Second Line	:
City	:	DENTON
State	:	TX
Zip	:	76205-7589
Country	:	US
Telephone Number	:	940-202-0921
Fax Number	:

Provider Business Practice Location Address
First Line	:	2220 SAN JACINTO BLVD # 235G
Second Line	:
City	:	DENTON
State	:	TX
Zip	:	76205-7589
Country	:	US
Telephone Number	:	940-202-0921
Fax Number	:

Authorized Official
Title or Position	:	THERAPIST
Name	:	JOSE MANUEL CHAIDEZ
Credential	:	LCSW
Telephone Number	:	940-202-0921

Provider Enumeration Date	:	12/13/2025
Last Update Date	:	12/13/2025

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