Provider Demographics
NPI:1144759978
Name:AVERA, JOSEPH E (LPC, LCDC)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:E
Last Name:AVERA
Suffix:
Gender:M
Credentials:LPC, LCDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13711 PEBBLE OAK DR
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78231-1817
Mailing Address - Country:US
Mailing Address - Phone:210-844-2733
Mailing Address - Fax:
Practice Address - Street 1:12500 NW MILITARY HWY STE 250
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78231-2000
Practice Address - Country:US
Practice Address - Phone:210-844-2733
Practice Address - Fax:210-844-2733
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-06
Last Update Date:2018-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX13783101YA0400X
TX34643101YM0800X
101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health