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General NPI Number Information
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NPI Number | 1093589376
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Entity Type | Organization
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Legal Business Name | MARIA T AVALOS
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Dates
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Enumeration Date | 11/08/2023
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Last Update Date | 11/08/2023
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Provider Practice Location Address
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Address Line | 8350 W GRANDRIDGE BLVD STE 200
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City | KENNEWICK
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State | WA
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Zip | 99336-1678
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Country | US
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Telephone | 509-851-7740
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 4464
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City | PASCO
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State | WA
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Zip | 99302-4464
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Country | US
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Telephone | 509-851-7740
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MARIA T AVALOS
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Credential | EDM LMCH
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Telephone | 509-851-7740
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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