Provider Demographics
NPI:1518192764
Name:TVEITO, JAY F (LCDC, MA)
Entity Type:Individual
Prefix:MR
First Name:JAY
Middle Name:F
Last Name:TVEITO
Suffix:
Gender:M
Credentials:LCDC, MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5001 N PIEDRAS ST
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79930-4210
Mailing Address - Country:US
Mailing Address - Phone:915-564-6159
Mailing Address - Fax:915-564-7867
Practice Address - Street 1:5001 N PIEDRAS ST
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79930-4210
Practice Address - Country:US
Practice Address - Phone:915-564-6159
Practice Address - Fax:915-564-7867
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-18
Last Update Date:2009-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX9390101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)