MEDICARE: CHRISTOPHER AVILA LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	58350	TX
2	104100000X	Social Worker	58350	TX

General Provider Information

NPI Number	:	1417407883
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHRISTOPHER AVILA LCSW

Provider Business Mailing Address
First Line	:	1148 W PIONEER PKWY STE B
Second Line	:
City	:	ARLINGTON
State	:	TX
Zip	:	76013-6385
Country	:	US
Telephone Number	:	682-405-7689
Fax Number	:	682-231-9844

Provider Business Practice Location Address
First Line	:	1148 W PIONEER PKWY STE B
Second Line	:
City	:	ARLINGTON
State	:	TX
Zip	:	76013-6385
Country	:	US
Telephone Number	:	682-405-7689
Fax Number	:	682-231-9844

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/10/2016
Last Update Date	:	04/11/2025

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