Provider Demographics
NPI:1972285138
Name:AVANZA COUNSELING PLLC
Entity Type:Organization
Organization Name:AVANZA COUNSELING PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ODETTE
Authorized Official - Middle Name:OJEDA
Authorized Official - Last Name:RIVERA
Authorized Official - Suffix:
Authorized Official - Credentials:LCPC
Authorized Official - Phone:708-257-1046
Mailing Address - Street 1:1926 W 22ND PL
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60608-4206
Mailing Address - Country:US
Mailing Address - Phone:708-257-1046
Mailing Address - Fax:
Practice Address - Street 1:917 W 18TH ST STE 204
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60608-2400
Practice Address - Country:US
Practice Address - Phone:708-257-1046
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-07
Last Update Date:2023-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty