Provider Demographics
NPI:1952471229
Name:AVALON SOCIAL SERVICES, INC.
Entity Type:Organization
Organization Name:AVALON SOCIAL SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:ERIC
Authorized Official - Last Name:BELLETT
Authorized Official - Suffix:
Authorized Official - Credentials:MPA
Authorized Official - Phone:210-404-9399
Mailing Address - Street 1:18007 SUMMER KNOLL DR
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78258-3401
Mailing Address - Country:US
Mailing Address - Phone:210-404-9399
Mailing Address - Fax:210-481-7175
Practice Address - Street 1:1731 N COMAL
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78212-4214
Practice Address - Country:US
Practice Address - Phone:210-735-7275
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00294RMedicare ID - Type Unspecified