Basic Information
| Provider Information | |||||||||
| NPI: | 1184004954 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CHAVEZ | ||||||||
| FirstName: | MICHAEL | ||||||||
| MiddleName: | RYAN | ||||||||
| NamePrefix: | MR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MSW, ACSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 317 W F ST | ||||||||
| Address2: | |||||||||
| City: | ONTARIO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 917623205 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9099867111 | ||||||||
| FaxNumber: | 9099860941 | ||||||||
| Practice Location | |||||||||
| Address1: | 317 W F ST | ||||||||
| Address2: | |||||||||
| City: | ONTARIO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 917623205 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9099867111 | ||||||||
| FaxNumber: | 9099860941 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/05/2015 | ||||||||
| LastUpdateDate: | 06/05/2015 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | 31960 | CA | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.