Provider Demographics
NPI:1598849416
Name:CHAVEZ, MARIO M
Entity Type:Individual
Prefix:MR
First Name:MARIO
Middle Name:M
Last Name:CHAVEZ
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:PO BOX 640
Mailing Address - Street 2:
Mailing Address - City:CLOVIS
Mailing Address - State:NM
Mailing Address - Zip Code:88102-0640
Mailing Address - Country:US
Mailing Address - Phone:575-309-7536
Mailing Address - Fax:
Practice Address - Street 1:501 COMMERCE WAY STE 6
Practice Address - Street 2:
Practice Address - City:CLOVIS
Practice Address - State:NM
Practice Address - Zip Code:88101-4870
Practice Address - Country:US
Practice Address - Phone:575-208-0028
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-25
Last Update Date:2018-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor