Healthcare Provider Details

I. General information

NPI: 1700126117
Provider Name (Legal Business Name): ALEXANDER ANTHONY AVILA M.A.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/21/2013
Last Update Date: 02/21/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7921 SOUTHPARK PLZ SUITE 204
LITTLETON CO
80120-5630
US

IV. Provider business mailing address

7921 SOUTHPARK PLZ SUITE 204
LITTLETON CO
80120-5630
US

V. Phone/Fax

Practice location:
  • Phone: 720-489-8555
  • Fax: 720-489-8304
Mailing address:
  • Phone: 720-489-8555
  • Fax: 720-489-8304

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberNLC0011263
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: