Provider Demographics
NPI:1366839524
Name:LAYNE-CHAVEZ, JEHAN (LCSW)
Entity Type:Individual
Prefix:
First Name:JEHAN
Middle Name:
Last Name:LAYNE-CHAVEZ
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:499 PALOMITA CT
Mailing Address - Street 2:
Mailing Address - City:TAOS
Mailing Address - State:NM
Mailing Address - Zip Code:87571-6857
Mailing Address - Country:US
Mailing Address - Phone:575-751-7688
Mailing Address - Fax:575-751-7208
Practice Address - Street 1:217 PASEO DEL PUEBLO NORTE STE E
Practice Address - Street 2:
Practice Address - City:TAOS
Practice Address - State:NM
Practice Address - Zip Code:87571-5963
Practice Address - Country:US
Practice Address - Phone:575-825-3522
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-24
Last Update Date:2023-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMX-089061041C0700X
NMSWB-2022-01071041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical