Provider Demographics
NPI:1124037080
Name:CHEVALIER, MARC CHARLES (LCSW)
Entity Type:Individual
Prefix:MR
First Name:MARC
Middle Name:CHARLES
Last Name:CHEVALIER
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:123 COMMERCE ST
Mailing Address - Street 2:SUITE C
Mailing Address - City:KERRVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78028-4950
Mailing Address - Country:US
Mailing Address - Phone:830-792-4477
Mailing Address - Fax:830-792-4546
Practice Address - Street 1:201 BAY WEST BLVD.
Practice Address - Street 2:
Practice Address - City:HORSESHOE BAY
Practice Address - State:TX
Practice Address - Zip Code:78657
Practice Address - Country:US
Practice Address - Phone:830-598-5968
Practice Address - Fax:830-596-2187
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-07
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX050431041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0912EMedicare ID - Type UnspecifiedLCSW