Healthcare Provider Details

I. General information

NPI: 1457261265
Provider Name (Legal Business Name): KENNETH PATRICK CHAVEZ MA, MS, LMHC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/11/2026
Last Update Date: 09/11/2026
Certification Date: 09/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 UNIVERSITY OF NEW MEXICO # 63870
ALBUQUERQUE NM
87131-0001
US

IV. Provider business mailing address

6000 CORTADERIA ST NE APT 6202
ALBUQUERQUE NM
87111-8007
US

V. Phone/Fax

Practice location:
  • Phone: 505-277-3136
  • Fax:
Mailing address:
  • Phone: 505-369-9314
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberCTB-2026-0598
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: