Provider Demographics
NPI:1598960353
Name:CHAVEZ, ROBIN DEANNE (BA, CAC 111)
Entity Type:Individual
Prefix:MRS
First Name:ROBIN
Middle Name:DEANNE
Last Name:CHAVEZ
Suffix:
Gender:F
Credentials:BA, CAC 111
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35 N ASH ST
Mailing Address - Street 2:
Mailing Address - City:CORTEZ
Mailing Address - State:CO
Mailing Address - Zip Code:81321-3201
Mailing Address - Country:US
Mailing Address - Phone:970-565-4109
Mailing Address - Fax:970-565-8804
Practice Address - Street 1:35 N ASH ST
Practice Address - Street 2:
Practice Address - City:CORTEZ
Practice Address - State:CO
Practice Address - Zip Code:81321-3201
Practice Address - Country:US
Practice Address - Phone:970-565-4109
Practice Address - Fax:970-565-8804
Is Sole Proprietor?:No
Enumeration Date:2007-06-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO3344101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)