Provider Demographics
NPI:1043429830
Name:AAVERLEE CLINICAL ASSOCIATES
Entity Type:Organization
Organization Name:AAVERLEE CLINICAL ASSOCIATES
Other - Org Name:AAVERLEE CLINICAL ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:B
Authorized Official - Last Name:PFEIFFER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:361-814-2273
Mailing Address - Street 1:PO BOX 61274
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78466-1274
Mailing Address - Country:US
Mailing Address - Phone:361-814-2273
Mailing Address - Fax:361-814-2274
Practice Address - Street 1:4455 S PADRE ISLAND DR
Practice Address - Street 2:SUITE 101
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78411-5101
Practice Address - Country:US
Practice Address - Phone:361-814-2273
Practice Address - Fax:361-814-2274
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-21
Last Update Date:2020-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX165091041C0700X
TX3723106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX119744403Medicaid
TX00S10TOtherBLUE CROSS BLUE SHIELD