Provider Demographics
NPI:1629170204
Name:CHAVEZ-HUMBLE, BENITA VERONICA (MA)
Entity Type:Individual
Prefix:MRS
First Name:BENITA
Middle Name:VERONICA
Last Name:CHAVEZ-HUMBLE
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1216 SHERIDAN AVE
Mailing Address - Street 2:
Mailing Address - City:CHICO
Mailing Address - State:CA
Mailing Address - Zip Code:95926-2712
Mailing Address - Country:US
Mailing Address - Phone:530-894-1646
Mailing Address - Fax:530-345-7766
Practice Address - Street 1:1216 SHERIDAN AVE
Practice Address - Street 2:
Practice Address - City:CHICO
Practice Address - State:CA
Practice Address - Zip Code:95926-2712
Practice Address - Country:US
Practice Address - Phone:530-894-1646
Practice Address - Fax:530-345-7766
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC31305106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist