Healthcare Provider Details

I. General information

NPI: 1124613021
Provider Name (Legal Business Name): EVELYN CHAVEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/03/2021
Last Update Date: 05/04/2026
Certification Date: 05/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23133 HAWTHORNE BLVD STE B10
TORRANCE CA
90505-3776
US

IV. Provider business mailing address

110 W 6TH ST UNIT 262
AZUSA CA
91702-6726
US

V. Phone/Fax

Practice location:
  • Phone: 213-222-6553
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberAMFT156061
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberAPCC19874
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: