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NPI Code Detail

MEDICARE: MR. DARRYL ANTHONY AVERY II

MEDICARE: MR. DARRYL ANTHONY AVERY II
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
1101Y00000XCounselor

General Provider Information

NPI Number : 1912737727
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. DARRYL ANTHONY AVERY II
Provider Business Mailing Address
First Line : 10694 GREENBELT DR
Second Line :
City : PEYTON
State : CO
Zip : 80831-7060
Country : US
Telephone Number : 843-468-8062
Fax Number :
Provider Business Practice Location Address
First Line : 4955 BRADLEY RD
Second Line :
City : COLORADO SPRINGS
State : CO
Zip : 80911-3265
Country : US
Telephone Number : 843-468-8062
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/06/2024
Last Update Date : 04/01/2025

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