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General NPI Number Information
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NPI Number | 1174643282
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Entity Type | Individual
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Provider Name | AVNI VYAS PH.D
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Gender | Female
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Dates
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Enumeration Date | 03/30/2007
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Last Update Date | 11/27/2023
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Provider Practice Location Address
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Address Line | 10725 EAST SOUTHLAKE BLVD 102
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City | SOUTHLAKE
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State | TX
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Zip | 76092-6457
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Country | US
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Telephone | 817-618-9307
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Fax | 817-977-8553
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Provider Business Mailing Address
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Address Line | 4705 LAFITE LN
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City | COLLEYVILLE
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State | TX
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Zip | 76034-1384
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Country | US
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Telephone | 817-618-9307
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Fax | 817-977-8553
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 31570
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 31570
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License Number State | TX
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