Healthcare Provider Details

I. General information

NPI: 1992092704
Provider Name (Legal Business Name): ERIC CHAVEZ LMHC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/30/2011
Last Update Date: 06/30/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

540 CHAMA ST NE STE 2
ALBUQUERQUE NM
87108-2017
US

IV. Provider business mailing address

540 CHAMA ST NE STE 2
ALBUQUERQUE NM
87108-2017
US

V. Phone/Fax

Practice location:
  • Phone: 505-265-0753
  • Fax: 505-268-5722
Mailing address:
  • Phone: 505-265-0753
  • Fax: 505-268-5722

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number0138101
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: