Healthcare Provider Details

I. General information

NPI: 1447554548
Provider Name (Legal Business Name): AMY RENEE CHAVARRIA LPCC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/04/2011
Last Update Date: 06/25/2024
Certification Date: 06/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 E MESCALERO RD
ROSWELL NM
88201-6542
US

IV. Provider business mailing address

1513 HOOT OWL CT
HOBBS NM
88242-0969
US

V. Phone/Fax

Practice location:
  • Phone: 575-755-2272
  • Fax: 575-622-3325
Mailing address:
  • Phone: 575-631-8591
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number0186841
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: