Healthcare Provider Details

I. General information

NPI: 1790466282
Provider Name (Legal Business Name): SARAH JESSICA CHAVEZ M.S
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/27/2023
Last Update Date: 08/22/2026
Certification Date: 08/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5201 GREAT AMERICA PKWY
SANTA CLARA CA
95054-1122
US

IV. Provider business mailing address

6545 E 32ND LN
YUMA AZ
85365-4881
US

V. Phone/Fax

Practice location:
  • Phone: 323-205-7088
  • Fax:
Mailing address:
  • Phone: 928-503-9593
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPCC21279
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: