Provider Demographics
NPI:1164420709
Name:OATES, AVANELL POWER (PHD)
Entity Type:Individual
Prefix:DR
First Name:AVANELL
Middle Name:POWER
Last Name:OATES
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1623 HOMER COOPER ROAD
Mailing Address - Street 2:
Mailing Address - City:MARSHALL
Mailing Address - State:TX
Mailing Address - Zip Code:75672
Mailing Address - Country:US
Mailing Address - Phone:903-938-8550
Mailing Address - Fax:
Practice Address - Street 1:531 GASLIGHT BLVD.
Practice Address - Street 2:
Practice Address - City:LUFKIN
Practice Address - State:TX
Practice Address - Zip Code:75904
Practice Address - Country:US
Practice Address - Phone:936-632-7010
Practice Address - Fax:936-632-9602
Is Sole Proprietor?:No
Enumeration Date:2005-07-08
Last Update Date:2010-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX24805103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX171800901Medicaid
TX86946AOtherBCBS
TX171800901Medicaid