Provider Demographics
NPI:1821368804
Name:CHAVEZ COUNSELING & CONSULTATIONS
Entity Type:Organization
Organization Name:CHAVEZ COUNSELING & CONSULTATIONS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL MENTAL HEALTH COUNSELOR
Authorized Official - Prefix:MS
Authorized Official - First Name:CARMEN
Authorized Official - Middle Name:C
Authorized Official - Last Name:CHAVEZ
Authorized Official - Suffix:
Authorized Official - Credentials:LPCC, LADAC
Authorized Official - Phone:575-437-3237
Mailing Address - Street 1:1505 WALNUT DR
Mailing Address - Street 2:
Mailing Address - City:ALAMOGORDO
Mailing Address - State:NM
Mailing Address - Zip Code:88310-4547
Mailing Address - Country:US
Mailing Address - Phone:575-437-3237
Mailing Address - Fax:
Practice Address - Street 1:1505 WALNUT DR
Practice Address - Street 2:
Practice Address - City:ALAMOGORDO
Practice Address - State:NM
Practice Address - Zip Code:88310-4547
Practice Address - Country:US
Practice Address - Phone:575-437-3237
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-06
Last Update Date:2012-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM0106881251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM51575507Medicaid