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General NPI Number Information
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NPI Number | 1023373446
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Entity Type | Individual
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Provider Name | LLENA H CHAVIS L.C.S.W.
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Gender | Female
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Dates
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Enumeration Date | 07/11/2012
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Last Update Date | 07/11/2012
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Provider Practice Location Address
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Address Line | 629 N 4TH ST
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City | MURRAY
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State | KY
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Zip | 42071-2152
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Country | US
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Telephone | 270-227-3505
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Fax | 270-809-3469
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Provider Business Mailing Address
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Address Line | 1013 STORY AVE
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City | MURRAY
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State | KY
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Zip | 42071-2464
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Country | US
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Telephone | 270-227-3505
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Fax | 270-809-3469
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 2064
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License Number State | KY
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