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General NPI Number Information
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NPI Number | 1144781246
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Entity Type | Individual
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Provider Name | ELLEE CHAVEZ
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Gender | Female
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Dates
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Enumeration Date | 03/29/2019
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Last Update Date | 02/15/2022
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Provider Practice Location Address
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Address Line | 1425 W FOOTHILL BLVD FL AVE3
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City | UPLAND
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State | CA
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Zip | 91786-8007
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Country | US
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Telephone | 866-396-3306
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Fax |
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Provider Business Mailing Address
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Address Line | 5225 CANYON CREST DR STE 71-2131
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City | RIVERSIDE
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State | CA
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Zip | 92507-6301
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Country | US
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Telephone |
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Fax |
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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 | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | AMFT129545
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License Number State | CA
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