Provider Demographics
NPI:1376001156
Name:CHAIDEZ, JOSE MANUEL
Entity Type:Individual
Prefix:
First Name:JOSE
Middle Name:MANUEL
Last Name:CHAIDEZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5509 PLEASANT VALLEY DR STE 70
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75023-5225
Mailing Address - Country:US
Mailing Address - Phone:469-885-1850
Mailing Address - Fax:972-581-9191
Practice Address - Street 1:5509 PLEASANT VALLEY DR STE 70
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75023-5225
Practice Address - Country:US
Practice Address - Phone:469-885-1850
Practice Address - Fax:972-581-9191
Is Sole Proprietor?:No
Enumeration Date:2019-03-11
Last Update Date:2021-09-01
Deactivation Date:2021-06-01
Deactivation Code:
Reactivation Date:2021-08-20
Provider Licenses
StateLicense IDTaxonomies
TX66320104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker