Provider Demographics
NPI:1538438585
Name:CHAVEZ, MINDY FAITH (MS, LMFT)
Entity type:Individual
Prefix:MRS
First Name:MINDY
Middle Name:FAITH
Last Name:CHAVEZ
Suffix:
Gender:F
Credentials:MS, LMFT
Other - Prefix:MRS
Other - First Name:MELINDA
Other - Middle Name:FAITH
Other - Last Name:CHAVEZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:10200 LEHIGH AVE
Mailing Address - Street 2:
Mailing Address - City:MONTCLAIR
Mailing Address - State:CA
Mailing Address - Zip Code:91763-3550
Mailing Address - Country:US
Mailing Address - Phone:909-445-1616
Mailing Address - Fax:909-445-1620
Practice Address - Street 1:10200 LEHIGH AVE
Practice Address - Street 2:
Practice Address - City:MONTCLAIR
Practice Address - State:CA
Practice Address - Zip Code:91763-3550
Practice Address - Country:US
Practice Address - Phone:909-445-1616
Practice Address - Fax:909-445-1620
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-20
Last Update Date:2011-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 43109106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist