Provider Demographics
NPI:1093873135
Name:CHAVEZ, DIANE C (MA, LPCC, LSAA)
Entity type:Individual
Prefix:
First Name:DIANE
Middle Name:C
Last Name:CHAVEZ
Suffix:
Gender:F
Credentials:MA, LPCC, LSAA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:801 GUAYMAS PL NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87108-2331
Mailing Address - Country:US
Mailing Address - Phone:505-238-7468
Mailing Address - Fax:
Practice Address - Street 1:4425 JUAN TABO BLVD NE STE 112
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87111-2684
Practice Address - Country:US
Practice Address - Phone:505-503-6800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-04
Last Update Date:2025-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM0082381101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health