Kaylee Briana Chavez

Individual provider Active NPI Addiction (Substance Use Disorder) Counselor · Isleta, NM

NPI 1760050652 · NPPES record last updated Jun 16, 2021

Key facts

NPI
1760050652
Entity type
Individual (NPI type 1)
Primary specialty
Addiction (Substance Use Disorder) Counselor 101YA0400X
License
CSA0212871 (NM)
Practice address
01 Sagebrush
Isleta, NM 87022
Phone
(505) 869-4866
Fax
(505) 869-4881
NPI assigned
Jun 16, 2021
Sex
Female
Sole proprietor
No

Medicare participation

Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)
No

State licenses

LicenseStateTypeSpecialty
CSA0212871NMMDAddiction (Substance Use Disorder) Counselor

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Addiction (Substance Use Disorder) Counselor 101YA0400X CSA0212871 NM Yes

Addresses

Primary practice location

01 Sagebrush
Isleta, NM 87022

Mailing address

P.O Box 640
Isleta, NM 87022-0640
Phone (505) 869-4866

Other identifiers

IdentifierTypeStateIssuer
CSA0212871OtherNMLICENSE

Other providers in Isleta, NM

All providers in Isleta, NM · Addiction (Substance Use Disorder) Counselor in New Mexico

Sources for this page

Verify at the official NPI Registry.