Individual
TANA CHAVEZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
P.O BOX 4339, SAN FELIPE PUEBLO, NM 87001
(505) 771-1463
(505) 771-9994
Mailing address
9201 MONTGOMERY BLVD NE STE 5, ALBUQUERQUE, NM 87111-2468
(505) 217-1717
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
CSA0223991
NM
175T00000X
Peer Specialist
Primary
1115
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
21720827
—
NM
Enumeration date
05/05/2021
Last updated
04/09/2024
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