Provider Demographics
NPI:1821311911
Name:CHAVEZ, LETICIA J (PSYD)
Entity Type:Individual
Prefix:DR
First Name:LETICIA
Middle Name:J
Last Name:CHAVEZ
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:6737 N MILBURN AVE
Mailing Address - Street 2:STE 160 PMB 103
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93722-2141
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:790 W SHAW AVE
Practice Address - Street 2:SUITE 280
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93704-2396
Practice Address - Country:US
Practice Address - Phone:559-575-0475
Practice Address - Fax:559-575-0474
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-03
Last Update Date:2016-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY22998103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical