Healthcare Provider Details

I. General information

NPI: 1467842567
Provider Name (Legal Business Name): JAMES CHAVEZ MSW, CSW-I
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/27/2015
Last Update Date: 04/25/2022
Certification Date: 04/25/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12450 VAN NUYS BLVD STE 200
PACOIMA CA
91331-1393
US

IV. Provider business mailing address

1005 WIGWAM PKWY APT 24106
HENDERSON NV
89074-8264
US

V. Phone/Fax

Practice location:
  • Phone: 818-896-1161
  • Fax: 818-896-5069
Mailing address:
  • Phone: 818-398-7882
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberIC-1876
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: