Provider Demographics
NPI:1922395409
Name:AVELAR, ANTHONY L (CAC I)
Entity Type:Individual
Prefix:MR
First Name:ANTHONY
Middle Name:L
Last Name:AVELAR
Suffix:
Gender:M
Credentials:CAC I
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1530 W 13TH AVE
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80204-2402
Mailing Address - Country:US
Mailing Address - Phone:303-698-2300
Mailing Address - Fax:
Practice Address - Street 1:1530 W 13TH AVE
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80204-2402
Practice Address - Country:US
Practice Address - Phone:303-698-2300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-07-05
Last Update Date:2011-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO6789101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO93401833Medicaid