Provider Demographics
NPI:1710147921
Name:AVILA, EFRAIN JR (EDD, LPC, LCPC)
Entity Type:Individual
Prefix:MR
First Name:EFRAIN
Middle Name:
Last Name:AVILA
Suffix:JR
Gender:M
Credentials:EDD, LPC, LCPC
Other - Prefix:
Other - First Name:EFRAIN
Other - Middle Name:
Other - Last Name:AVILA-JUARBE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:EDD, LPC, LCPC
Mailing Address - Street 1:P.O. BOX 2203
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:CA
Mailing Address - Zip Code:94568
Mailing Address - Country:US
Mailing Address - Phone:815-985-8924
Mailing Address - Fax:210-924-3557
Practice Address - Street 1:94 BRIGGS ST STE 700
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78224-1272
Practice Address - Country:US
Practice Address - Phone:210-924-3556
Practice Address - Fax:210-924-3557
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-11
Last Update Date:2015-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX64717101Y00000X, 101YM0800X, 101YP2500X
IL180-004466101YP2500X
IL180004466101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health