Breanna Chavez
Individual provider Active NPI Behavior Technician · Gallup, NM
NPI 1609475250 · NPPES record last updated Oct 23, 2020
Key facts
- NPI
- 1609475250
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Behavior Technician 106S00000X
- Practice address
- 1302 Country Club PL
Gallup, NM 87301-4949 - Phone
- (505) 290-4723
- NPI assigned
- Oct 23, 2020
- Sex
- Female
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Behavior Technician | 106S00000X | Yes |
Addresses
Primary practice location
1302 Country Club PL
Gallup, NM 87301-4949
Mailing address
1302 Country Club PL
Gallup, NM 87301-4949
Other providers in Gallup, NM
- Paul William Charlton
- Duane Chase
- Renee Chase
- Jovanna Chavarria
- Olivia Chavez Busch
- Dariquetta Dorry Chavez
- Deanna Marlene Chavez
- Desiray Chavez
- Diana D Chavez
- Leticia Monique Chavez
All providers in Gallup, NM · Behavior Technician in New Mexico
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 23, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.