Provider Demographics
NPI:1134703218
Name:CHAVEZ, MARYSOL
Entity Type:Individual
Prefix:
First Name:MARYSOL
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 1:1355 S COLORADO BLVD STE C100
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80222-3358
Mailing Address - Country:US
Mailing Address - Phone:303-756-0308
Mailing Address - Fax:303-756-0308
Practice Address - Street 1:1355 S COLORADO BLVD STE C100
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80222-3358
Practice Address - Country:US
Practice Address - Phone:303-756-0308
Practice Address - Fax:303-756-0308
Is Sole Proprietor?:No
Enumeration Date:2021-05-05
Last Update Date:2021-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor