Provider Demographics
NPI:1780823732
Name:AVERY, BECKY DARLENE (MDIV, LCSW)
Entity Type:Individual
Prefix:MS
First Name:BECKY
Middle Name:DARLENE
Last Name:AVERY
Suffix:
Gender:F
Credentials:MDIV, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2316 N WAHSATCH AVE
Mailing Address - Street 2:#240
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80907-6968
Mailing Address - Country:US
Mailing Address - Phone:719-331-7445
Mailing Address - Fax:
Practice Address - Street 1:1426 N HANCOCK AVE
Practice Address - Street 2:SUITE 5N
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80903-2618
Practice Address - Country:US
Practice Address - Phone:719-331-7445
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-02-16
Last Update Date:2015-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO18421041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical