MEDICARE: DR. RUDY P CHAVEZ D.TH.CC, LADAC, 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	101YM0800X	Mental Health Counselor	CTB-2026-0064	NM

General Provider Information

NPI Number	:	1861025686
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RUDY P CHAVEZ D.TH.CC, LADAC, LMHC

Provider Business Mailing Address
First Line	:	702 N WYOMING AVE
Second Line	:
City	:	ROSWELL
State	:	NM
Zip	:	88201-2173
Country	:	US
Telephone Number	:	505-205-2871
Fax Number	:

Provider Business Practice Location Address
First Line	:	702 N WYOMING AVE
Second Line	:
City	:	ROSWELL
State	:	NM
Zip	:	88201-2173
Country	:	US
Telephone Number	:	505-205-2871
Fax Number	:

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

Provider Enumeration Date	:	02/20/2020
Last Update Date	:	04/08/2026

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