Individual
TANA CHAVEZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
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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