Provider Demographics
NPI:1043753676
Name:CHAVEZ, COURTNEY
Entity Type:Individual
Prefix:MRS
First Name:COURTNEY
Middle Name:
Last Name:CHAVEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3309 UNICORN LAKE BLVD
Mailing Address - Street 2:SUITE 161
Mailing Address - City:DENTON
Mailing Address - State:TX
Mailing Address - Zip Code:76210-0102
Mailing Address - Country:US
Mailing Address - Phone:940-382-0109
Mailing Address - Fax:
Practice Address - Street 1:3309 UNICORN LAKE BLVD
Practice Address - Street 2:SUITE 161
Practice Address - City:DENTON
Practice Address - State:TX
Practice Address - Zip Code:76210-0102
Practice Address - Country:US
Practice Address - Phone:940-382-0109
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-11-30
Last Update Date:2016-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX72241101YP2500X
TX202286106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist