Provider Demographics
NPI:1114264389
Name:CHAVEZ, CHRISTINE R (PSYD, LPC)
Entity Type:Individual
Prefix:DR
First Name:CHRISTINE
Middle Name:R
Last Name:CHAVEZ
Suffix:
Gender:F
Credentials:PSYD, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1067 E US HIGHWAY 24 # 294
Mailing Address - Street 2:
Mailing Address - City:WOODLAND PARK
Mailing Address - State:CO
Mailing Address - Zip Code:80863-2120
Mailing Address - Country:US
Mailing Address - Phone:719-358-1721
Mailing Address - Fax:719-309-0731
Practice Address - Street 1:422 E VERMIJO AVE STE 206
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80903-3778
Practice Address - Country:US
Practice Address - Phone:719-358-1721
Practice Address - Fax:719-309-0731
Is Sole Proprietor?:No
Enumeration Date:2013-01-08
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO11191101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO15621839Medicaid
12529685OtherCAQH