Healthcare Provider Details

I. General information

NPI: 1871500660
Provider Name (Legal Business Name): CARMEN CHAVEZ LPCC, LADAC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/02/2006
Last Update Date: 05/03/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1900 10TH ST
ALAMOGORDO NM
88310-5053
US

IV. Provider business mailing address

1900 10TH ST
ALAMOGORDO NM
88310-5053
US

V. Phone/Fax

Practice location:
  • Phone: 575-437-7404
  • Fax: 575-439-2860
Mailing address:
  • Phone: 575-437-7404
  • Fax: 575-439-2860

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number0088881
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number0106881
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: