Provider Demographics
NPI:1467099788
Name:CHAVEZ, DIANA (LMSW)
Entity Type:Individual
Prefix:
First Name:DIANA
Middle Name:
Last Name:CHAVEZ
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1001 N 7TH AVE STE 260
Mailing Address - Street 2:
Mailing Address - City:POCATELLO
Mailing Address - State:ID
Mailing Address - Zip Code:83201-5788
Mailing Address - Country:US
Mailing Address - Phone:208-242-9028
Mailing Address - Fax:208-242-9115
Practice Address - Street 1:1001 N 7TH AVE STE 260
Practice Address - Street 2:
Practice Address - City:POCATELLO
Practice Address - State:ID
Practice Address - Zip Code:83201-5788
Practice Address - Country:US
Practice Address - Phone:208-242-9028
Practice Address - Fax:208-242-9115
Is Sole Proprietor?:No
Enumeration Date:2019-12-05
Last Update Date:2023-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID1041C0700XOtherTAXONOMY