Provider Demographics
NPI:1700411964
Name:CHAVEZ, FABIOLA (LCDC)
Entity Type:Individual
Prefix:
First Name:FABIOLA
Middle Name:
Last Name:CHAVEZ
Suffix:
Gender:F
Credentials:LCDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2400 TRAWOOD DR STE 301A
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79936-4122
Mailing Address - Country:US
Mailing Address - Phone:915-747-3605
Mailing Address - Fax:
Practice Address - Street 1:2400 TRAWOOD DR STE 301A
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79936-4122
Practice Address - Country:US
Practice Address - Phone:915-747-3605
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-09
Last Update Date:2020-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX14853101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)