Provider Demographics
NPI:1942774351
Name:CHAVEZ, NAYELI Y (PHD)
Entity Type:Individual
Prefix:DR
First Name:NAYELI
Middle Name:Y
Last Name:CHAVEZ
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2030 W 18TH PL
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60608-4993
Mailing Address - Country:US
Mailing Address - Phone:312-420-6006
Mailing Address - Fax:
Practice Address - Street 1:65 E WACKER PL STE 2240
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60601-7217
Practice Address - Country:US
Practice Address - Phone:312-621-9002
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-18
Last Update Date:2019-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071008075103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical