Provider Demographics
NPI:1205841699
Name:AVALOS, ADANTE RAMON (LPC)
Entity Type:Individual
Prefix:MR
First Name:ADANTE
Middle Name:RAMON
Last Name:AVALOS
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1790 N LEE TREVINO DR
Mailing Address - Street 2:STE 501
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79936-4545
Mailing Address - Country:US
Mailing Address - Phone:915-849-7917
Mailing Address - Fax:915-849-7910
Practice Address - Street 1:1790 N LEE TREVINO DR
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79936-4545
Practice Address - Country:US
Practice Address - Phone:915-849-7917
Practice Address - Fax:915-849-7910
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-31
Last Update Date:2011-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX13656101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX113088201Medicaid