Healthcare Provider Details

I. General information

NPI: 1144427550
Provider Name (Legal Business Name): KARLA NOEMY CHAVEZ AMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/29/2007
Last Update Date: 05/19/2023
Certification Date: 05/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

516 N KAWEAH AVE
EXETER CA
93221-1200
US

IV. Provider business mailing address

516 N KAWEAH AVE
EXETER CA
93221-1200
US

V. Phone/Fax

Practice location:
  • Phone: 559-594-4969
  • Fax:
Mailing address:
  • Phone: 559-594-4969
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number90649
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number130576
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: