Provider Demographics
NPI:1326564865
Name:CHAVEZ, SARA (LIMHP, LCSW, LADC)
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:
Last Name:CHAVEZ
Suffix:
Gender:F
Credentials:LIMHP, LCSW, LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2230 GRIFFITH ST
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68503-1334
Mailing Address - Country:US
Mailing Address - Phone:308-830-2513
Mailing Address - Fax:
Practice Address - Street 1:616 W 5TH ST
Practice Address - Street 2:
Practice Address - City:HASTINGS
Practice Address - State:NE
Practice Address - Zip Code:68901-5104
Practice Address - Country:US
Practice Address - Phone:402-463-5684
Practice Address - Fax:402-463-5686
Is Sole Proprietor?:No
Enumeration Date:2017-08-16
Last Update Date:2023-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE47064522095Medicaid
NE47064522900Medicaid
NE47064522904Medicaid