Provider Demographics
NPI:1174009047
Name:LOPEZ-CHAVEZ, TANIA GUADALUPE
Entity Type:Individual
Prefix:MS
First Name:TANIA
Middle Name:GUADALUPE
Last Name:LOPEZ-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 1:4312 BELLVILLE DR
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68521-1528
Mailing Address - Country:US
Mailing Address - Phone:402-840-2623
Mailing Address - Fax:
Practice Address - Street 1:4312 BELLVILLE DR
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68521-1528
Practice Address - Country:US
Practice Address - Phone:402-840-2623
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-13
Last Update Date:2018-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician