Provider Demographics
NPI:1174643282
Name:VYAS, AVNI (PHD)
Entity Type:Individual
Prefix:MS
First Name:AVNI
Middle Name:
Last Name:VYAS
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 1:4705 LAFITE LN
Mailing Address - Street 2:
Mailing Address - City:COLLEYVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:76034-1384
Mailing Address - Country:US
Mailing Address - Phone:817-618-9307
Mailing Address - Fax:817-977-8553
Practice Address - Street 1:10725 EAST SOUTHLAKE BLVD
Practice Address - Street 2:102
Practice Address - City:SOUTHLAKE
Practice Address - State:TX
Practice Address - Zip Code:76092-6457
Practice Address - Country:US
Practice Address - Phone:817-618-9307
Practice Address - Fax:817-977-8553
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-30
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX31570103T00000X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologist