Provider Demographics
NPI:1972014702
Name:CHAVEZ, YURITZY (EDS)
Entity Type:Individual
Prefix:MISS
First Name:YURITZY
Middle Name:
Last Name:CHAVEZ
Suffix:
Gender:F
Credentials:EDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6021 S 74TH AVE
Mailing Address - Street 2:
Mailing Address - City:SUMMIT
Mailing Address - State:IL
Mailing Address - Zip Code:60501-1500
Mailing Address - Country:US
Mailing Address - Phone:708-458-7260
Mailing Address - Fax:
Practice Address - Street 1:6021 S 74TH AVE
Practice Address - Street 2:
Practice Address - City:SUMMIT
Practice Address - State:IL
Practice Address - Zip Code:60501-1500
Practice Address - Country:US
Practice Address - Phone:708-458-7260
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-19
Last Update Date:2017-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1121146103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool