MEDICARE: ADOLPH CHAVEZ JR LCMFT LLC

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	106H00000X	Marriage & Family Therapist

General Provider Information

NPI Number	:	1588507677
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ADOLPH CHAVEZ JR LCMFT LLC

Provider Business Mailing Address
First Line	:	4688 N BRIARGATE CT
Second Line	:
City	:	PARK CITY
State	:	KS
Zip	:	67219-5525
Country	:	US
Telephone Number	:	316-305-8065
Fax Number	:	316-618-9584

Provider Business Practice Location Address
First Line	:	1999 N AMIDON AVE STE 232
Second Line	:
City	:	WICHITA
State	:	KS
Zip	:	67203-2123
Country	:	US
Telephone Number	:	316-779-3694
Fax Number	:	316-618-9584

Authorized Official
Title or Position	:	OWNER
Name	:	ADOLPH CHAVEZ JR.
Credential	:	LCMFT
Telephone Number	:	316-779-3694

Provider Enumeration Date	:	04/13/2026
Last Update Date	:	04/13/2026

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