MEDICARE: KATHY CHAVEZ

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	101YA0400X	Addiction (Substance Use Disorder) Counselor	R1608150425	CA

General Provider Information

NPI Number	:	1770370561
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHY CHAVEZ

Provider Business Mailing Address
First Line	:	898 N FAIR OAKS AVE STE A
Second Line	:
City	:	PASADENA
State	:	CA
Zip	:	91103-3065
Country	:	US
Telephone Number	:	626-797-1124
Fax Number	:

Provider Business Practice Location Address
First Line	:	898 N FAIR OAKS AVE STE A
Second Line	:
City	:	PASADENA
State	:	CA
Zip	:	91103-3065
Country	:	US
Telephone Number	:	626-797-1124
Fax Number	:

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

Provider Enumeration Date	:	04/23/2025
Last Update Date	:	04/23/2025

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Directions to “ KATHY CHAVEZ ” Practice Location

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