Healthcare Provider Details

I. General information

NPI: 1831505486
Provider Name (Legal Business Name): LIZBETH GONZALEZ CHAVEZ SWC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/03/2014
Last Update Date: 07/14/2026
Certification Date: 07/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1301 RIVERSIDE AVE
FORT COLLINS CO
80524-4374
US

IV. Provider business mailing address

825 SAIGA DR
SEVERANCE CO
80550-3808
US

V. Phone/Fax

Practice location:
  • Phone: 970-888-4070
  • Fax:
Mailing address:
  • Phone: 970-294-1982
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSWC.0000000707
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License NumberNA00737225
License Number StateCO
# 3
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberSWC.0000000707
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: