Provider Demographics
NPI:1053640169
Name:CHAVEZ, JOSEPH CHAVEZ (PHD)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:CHAVEZ
Last Name:CHAVEZ
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:810 ARCTURUS DR
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80905-7846
Mailing Address - Country:US
Mailing Address - Phone:719-231-0527
Mailing Address - Fax:
Practice Address - Street 1:13879 SINGLE LEAF CT
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80921-2969
Practice Address - Country:US
Practice Address - Phone:719-231-0527
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-12-18
Last Update Date:2009-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO4483101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health