Provider Demographics
NPI:1982814448
Name:AVILA, MICHAEL J (LMFT)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:J
Last Name:AVILA
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2652 NW ELM AVE
Mailing Address - Street 2:
Mailing Address - City:REDMOND
Mailing Address - State:OR
Mailing Address - Zip Code:97756-5526
Mailing Address - Country:US
Mailing Address - Phone:541-499-9703
Mailing Address - Fax:
Practice Address - Street 1:2652 NW ELM AVE
Practice Address - Street 2:
Practice Address - City:REDMOND
Practice Address - State:OR
Practice Address - Zip Code:97756-5526
Practice Address - Country:US
Practice Address - Phone:541-499-9703
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-23
Last Update Date:2020-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YP1600X
ORT1283106H00000X
NJ37FI00143600106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral