Provider Demographics
NPI:1407444326
Name:CHAVEZ, JORGE (PHD)
Entity Type:Individual
Prefix:
First Name:JORGE
Middle Name:
Last Name:CHAVEZ
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1802 W 6TH ST STE B
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78703-5372
Mailing Address - Country:US
Mailing Address - Phone:713-703-9527
Mailing Address - Fax:
Practice Address - Street 1:1802 W 6TH ST STE B
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78703-5372
Practice Address - Country:US
Practice Address - Phone:713-703-9527
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-06
Last Update Date:2021-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX38334103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical