Basic Information
| Provider Information | |||||||||
| NPI: | 1285178400 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CHAVES | ||||||||
| FirstName: | YELITZA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5950 NW BRENDA CIR | ||||||||
| Address2: | |||||||||
| City: | PORT ST LUCIE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 349863636 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7726268962 | ||||||||
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| Practice Location | |||||||||
| Address1: | 755 27TH AVE SW | ||||||||
| Address2: | |||||||||
| City: | VERO BEACH | ||||||||
| State: | FL | ||||||||
| PostalCode: | 329684200 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7722575264 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 12/07/2016 | ||||||||
| LastUpdateDate: | 12/07/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.