# DR. NICOLE CHAVEZ PSYCHOLOGICAL SERVICES P.C.

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1174261051
- **Authorized official:** DR. NICOLE CHAVEZ PSY.D. (CEO)
- **Authorized official phone:** (949) 280-4685

## Contact information

- **Practice address:** 427 E 17TH ST \# STF-1112, COSTA MESA, CA 92627-3201
- **Practice address phone:** (949) 280-4685
- **Mailing address:** 1555 MESA VERDE DR E APT 40K, COSTA MESA, CA 92626-5246
- **Mailing address phone:** (949) 280-4685

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 103TC2200X | Clinical Child & Adolescent Psychologist | — | NULL | Yes |
| 103TC2200X | Clinical Child & Adolescent Psychologist | — | — | Yes |

## Other

- **Enumeration date:** 05/21/2022
- **Last updated:** 05/21/2022