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General NPI Number Information
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NPI Number | 1174261051
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Entity Type | Organization
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Legal Business Name | DR. NICOLE CHAVEZ PSYCHOLOGICAL SERVICES P.C.
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Dates
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Enumeration Date | 05/21/2022
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Last Update Date | 05/21/2022
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Provider Practice Location Address
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Address Line | 427 E 17TH ST # STF-1112
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City | COSTA MESA
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State | CA
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Zip | 92627-3201
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Country | US
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Telephone | 949-280-4685
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Fax |
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Provider Business Mailing Address
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Address Line | 1555 MESA VERDE DR E APT 40K
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City | COSTA MESA
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State | CA
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Zip | 92626-5246
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Country | US
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Telephone | 949-280-4685
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | DR. NICOLE CHAVEZ
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Credential | PSY.D.
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Telephone | 949-280-4685
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC2200X
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Taxonomy Name | Clinical Child & Adolescent Psychologist
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License Number |
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License Number State |
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