Healthcare Provider Details

I. General information

NPI: 1982386082
Provider Name (Legal Business Name): TIANNA CHAVEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: TIANNA HOLMES

II. Dates (important events)

Enumeration Date: 08/07/2023
Last Update Date: 10/08/2026
Certification Date: 10/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4343 PAN AMERICAN FWY NE STE 221
ALBUQUERQUE NM
87107-6834
US

IV. Provider business mailing address

4343 PAN AMERICAN FWY NE STE 221
ALBUQUERQUE NM
87107-6834
US

V. Phone/Fax

Practice location:
  • Phone: 505-421-0814
  • Fax:
Mailing address:
  • Phone: 505-421-0814
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberCTB-2025-0614
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: