MEDICARE: NUVIA CHAVEZ-TELLEZ LPC, LMHC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	C5930	OR

General Provider Information

NPI Number	:	1457804981
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NUVIA CHAVEZ-TELLEZ LPC, LMHC

Provider Business Mailing Address
First Line	:	PO BOX 6149
Second Line	:
City	:	ALOHA
State	:	OR
Zip	:	97007-0149
Country	:	US
Telephone Number	:	503-352-8642
Fax Number	:	503-352-8658

Provider Business Practice Location Address
First Line	:	1715 NICHOLS LN
Second Line	:
City	:	FOREST GROVE
State	:	OR
Zip	:	97116-3216
Country	:	US
Telephone Number	:	503-359-4057
Fax Number	:	503-359-4756

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/02/2016
Last Update Date	:	03/03/2022

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