Provider Demographics
NPI:1225644594
Name:AVALOS, PATRICIA C (MS)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:C
Last Name:AVALOS
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1110 DOUGLAS AVE STE 2040
Mailing Address - Street 2:
Mailing Address - City:ALTAMONTE SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32714-2004
Mailing Address - Country:US
Mailing Address - Phone:407-285-6284
Mailing Address - Fax:
Practice Address - Street 1:1110 DOUGLAS AVE STE 2040
Practice Address - Street 2:
Practice Address - City:ALTAMONTE SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32714-2004
Practice Address - Country:US
Practice Address - Phone:407-285-6284
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-21
Last Update Date:2020-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLIMH20113101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health