Individual
IDALY CHAVEZ-SOTO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPC ASSOCIATE
Contact information
Practice address
1100 HEMPHILL ST, FORT WORTH, TX 76104-4666
(817) 916-4323
Mailing address
PO BOX 163781, FORT WORTH, TX 76161-3781
(682) 651-7621
(817) 887-3409
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
94533
TX
101YP2500X
Professional Counselor
94533
TX
Other
Enumeration date
05/30/2024
Last updated
05/30/2024
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