Provider Demographics
NPI:1659774206
Name:CHAVEZ, JANAE (BA)
Entity Type:Individual
Prefix:
First Name:JANAE
Middle Name:
Last Name:CHAVEZ
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2149 JOLLY RD STE 500
Mailing Address - Street 2:
Mailing Address - City:OKEMOS
Mailing Address - State:MI
Mailing Address - Zip Code:48864-6028
Mailing Address - Country:US
Mailing Address - Phone:517-347-4645
Mailing Address - Fax:
Practice Address - Street 1:2149 JOLLY RD STE 500
Practice Address - Street 2:
Practice Address - City:OKEMOS
Practice Address - State:MI
Practice Address - Zip Code:48864-6028
Practice Address - Country:US
Practice Address - Phone:517-347-4645
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-09-26
Last Update Date:2019-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
172V00000X
MI4101006890106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No172V00000XOther Service ProvidersCommunity Health Worker