Provider Demographics
NPI:1013162403
Name:CHAVEZ, RANDALL R (LPC)
Entity Type:Individual
Prefix:MR
First Name:RANDALL
Middle Name:R
Last Name:CHAVEZ
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:790 GENERATIONS DR
Mailing Address - Street 2:STE 410
Mailing Address - City:NEW BRAUNFELS
Mailing Address - State:TX
Mailing Address - Zip Code:78130-6720
Mailing Address - Country:US
Mailing Address - Phone:830-625-0599
Mailing Address - Fax:830-625-5877
Practice Address - Street 1:790 GENERATIONS DR
Practice Address - Street 2:STE 410
Practice Address - City:NEW BRAUNFELS
Practice Address - State:TX
Practice Address - Zip Code:78130-6720
Practice Address - Country:US
Practice Address - Phone:830-625-0599
Practice Address - Fax:830-625-5877
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-26
Last Update Date:2022-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX59612101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health