Provider Demographics
NPI:1508605536
Name:CHAVEZ, RICHARD (CSW, PLMHC)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:
Last Name:CHAVEZ
Suffix:
Gender:M
Credentials:CSW, PLMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:817 DESI LOOP
Mailing Address - Street 2:
Mailing Address - City:BELEN
Mailing Address - State:NM
Mailing Address - Zip Code:87002-8068
Mailing Address - Country:US
Mailing Address - Phone:575-835-4357
Mailing Address - Fax:505-514-0732
Practice Address - Street 1:1445 FRONTAGE RD NW
Practice Address - Street 2:
Practice Address - City:SOCORRO
Practice Address - State:NM
Practice Address - Zip Code:87801-5077
Practice Address - Country:US
Practice Address - Phone:575-835-4357
Practice Address - Fax:505-514-0732
Is Sole Proprietor?:No
Enumeration Date:2024-05-20
Last Update Date:2024-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMCTB-2024-0724101Y00000X
172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No172V00000XOther Service ProvidersCommunity Health Worker