Provider Demographics
NPI:1225205073
Name:AVERY, JEREMY SEVIER
Entity Type:Individual
Prefix:MR
First Name:JEREMY
Middle Name:SEVIER
Last Name:AVERY
Suffix:
Gender:M
Credentials:
Other - Prefix:MS
Other - First Name:MELYSSA
Other - Middle Name:
Other - Last Name:HINTZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:885 W 18TH ST
Mailing Address - Street 2:
Mailing Address - City:MERCED
Mailing Address - State:CA
Mailing Address - Zip Code:95340-4604
Mailing Address - Country:US
Mailing Address - Phone:209-726-3090
Mailing Address - Fax:
Practice Address - Street 1:815 W 18TH ST
Practice Address - Street 2:
Practice Address - City:MERCED
Practice Address - State:CA
Practice Address - Zip Code:95340-4604
Practice Address - Country:US
Practice Address - Phone:209-726-3090
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-12
Last Update Date:2012-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional