Healthcare Provider Details

I. General information

NPI: 1235066432
Provider Name (Legal Business Name): KIMBERLY CHAVEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/04/2026
Last Update Date: 05/04/2026
Certification Date: 05/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1526 SIERRA NORTE LOOP NE
RIO RANCHO NM
87144-2520
US

IV. Provider business mailing address

3923 RANCHO GUSTO NW
ALBUQUERQUE NM
87120-5817
US

V. Phone/Fax

Practice location:
  • Phone: 505-328-1288
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberCMH006289
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: