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General NPI Number Information
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NPI Number | 1578835179
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Entity Type | Individual
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Provider Name | SANDRA LEE CHAVEZ L.P.A.T
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Gender | Female
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Dates
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Enumeration Date | 01/30/2012
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Last Update Date | 01/30/2012
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Provider Practice Location Address
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Address Line | 428 LOS LENTES, S.E.
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City | LOS LUNAS
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State | NM
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Zip | 87031
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Country | US
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Telephone | 505-620-1911
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Fax | 505-865-7422
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Provider Business Mailing Address
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Address Line | P.O. BOX 730
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City | LOS LUNAS
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State | NM
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Zip | 87031
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Country | US
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Telephone | 505-620-1911
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 2414
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License Number State | NM
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