Provider Demographics
NPI:1568059152
Name:AVALOS, MAYRA A (PLMHP)
Entity Type:Individual
Prefix:
First Name:MAYRA
Middle Name:A
Last Name:AVALOS
Suffix:
Gender:F
Credentials:PLMHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 W 8TH ST STE A
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:NE
Mailing Address - Zip Code:68850-1971
Mailing Address - Country:US
Mailing Address - Phone:308-325-0627
Mailing Address - Fax:
Practice Address - Street 1:101 W 8TH ST STE A
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:NE
Practice Address - Zip Code:68850-1971
Practice Address - Country:US
Practice Address - Phone:308-325-0627
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-29
Last Update Date:2023-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE12433101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health