Provider Demographics
NPI:1922577733
Name:CHAVEZ, CHRISTINE (LMFT # 119692)
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:
Last Name:CHAVEZ
Suffix:
Gender:F
Credentials:LMFT # 119692
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1304 SILVER RIDGE WAY
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95831-3610
Mailing Address - Country:US
Mailing Address - Phone:916-642-6637
Mailing Address - Fax:
Practice Address - Street 1:9075 ELK GROVE BLVD STE 220A
Practice Address - Street 2:
Practice Address - City:ELK GROVE
Practice Address - State:CA
Practice Address - Zip Code:95624-2070
Practice Address - Country:US
Practice Address - Phone:916-686-9209
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-21
Last Update Date:2021-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA119692106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA14329010OtherCAQH PROVIEW