Provider Demographics
NPI:1184920118
Name:CHAVEZ, LAURA PATRICIA (MFTI, PPSC)
Entity type:Individual
Prefix:MS
First Name:LAURA
Middle Name:PATRICIA
Last Name:CHAVEZ
Suffix:
Gender:F
Credentials:MFTI, PPSC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1670 S AMPHLETT BLVD STE 115
Mailing Address - Street 2:
Mailing Address - City:SAN MATEO
Mailing Address - State:CA
Mailing Address - Zip Code:94402-2512
Mailing Address - Country:US
Mailing Address - Phone:650-286-3912
Mailing Address - Fax:
Practice Address - Street 1:1670 S AMPHLETT BLVD STE 115
Practice Address - Street 2:
Practice Address - City:SAN MATEO
Practice Address - State:CA
Practice Address - Zip Code:94402-2512
Practice Address - Country:US
Practice Address - Phone:650-286-3912
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-02-09
Last Update Date:2011-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAIMF 66038106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist