Healthcare Provider Details

I. General information

NPI: 1346757085
Provider Name (Legal Business Name): GERARDO ALVA CHAVEZ LPCC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/03/2018
Last Update Date: 02/04/2026
Certification Date: 02/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

78060 CALLE ESTADO
LA QUINTA CA
92253-2960
US

IV. Provider business mailing address

79405 HIGHWAY 111 STE 9-127
LA QUINTA CA
92253-8300
US

V. Phone/Fax

Practice location:
  • Phone: 760-899-6427
  • Fax:
Mailing address:
  • Phone: 760-899-6427
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number14770
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: