Provider Demographics
NPI:1891926762
Name:CHAVEZ, ALFRED C (BS)
Entity Type:Individual
Prefix:MR
First Name:ALFRED
Middle Name:C
Last Name:CHAVEZ
Suffix:
Gender:M
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 36216
Mailing Address - Street 2:
Mailing Address - City:FORT BAYARD
Mailing Address - State:NM
Mailing Address - Zip Code:88036-6216
Mailing Address - Country:US
Mailing Address - Phone:575-537-8831
Mailing Address - Fax:575-537-3760
Practice Address - Street 1:149 CAMINO DEL CIELO
Practice Address - Street 2:YUCCA LODGE
Practice Address - City:FORT BAYARD
Practice Address - State:NM
Practice Address - Zip Code:88036
Practice Address - Country:US
Practice Address - Phone:575-537-8831
Practice Address - Fax:575-537-3760
Is Sole Proprietor?:No
Enumeration Date:2009-07-27
Last Update Date:2009-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM3616101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)