Provider Demographics
NPI:1225893654
Name:LAABS, AVERY (TCADC)
Entity Type:Individual
Prefix:
First Name:AVERY
Middle Name:
Last Name:LAABS
Suffix:
Gender:F
Credentials:TCADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3200 OKOBOJI AVE TRLR 139
Mailing Address - Street 2:
Mailing Address - City:MILFORD
Mailing Address - State:IA
Mailing Address - Zip Code:51351-7192
Mailing Address - Country:US
Mailing Address - Phone:712-260-9892
Mailing Address - Fax:
Practice Address - Street 1:201 E 11TH ST
Practice Address - Street 2:
Practice Address - City:SPENCER
Practice Address - State:IA
Practice Address - Zip Code:51301-4460
Practice Address - Country:US
Practice Address - Phone:712-262-2922
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-15
Last Update Date:2024-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)