Basic Information
| Provider Information | |||||||||
| NPI: | 1700338985 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CHAVEZ | ||||||||
| FirstName: | LYNDSEY | ||||||||
| MiddleName: | NICOLE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 112 N FOWLER AVE APT 122 | ||||||||
| Address2: | |||||||||
| City: | CLOVIS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 936110719 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5593017469 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1470 W HERNDON AVE | ||||||||
| Address2: | SUITE 300 | ||||||||
| City: | FRESNO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 937110552 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5592562000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/04/2016 | ||||||||
| LastUpdateDate: | 11/15/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 11/15/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106H00000X | 96043 | CA | N | Behavioral Health & Social Service Providers | Marriage & Family Therapist | 106H00000X | 115214 | CA | Y | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
No ID Information.