Provider Demographics
NPI:1013755354
Name:AVIRA BEHAVIORAL PLLC
Entity type:Organization
Organization Name:AVIRA BEHAVIORAL PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:VIPULKUMAR
Authorized Official - Middle Name:
Authorized Official - Last Name:DEVANI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:346-500-4514
Mailing Address - Street 1:13500 W AIRPORT BLVD STE B
Mailing Address - Street 2:PMB 1048
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77498-6319
Mailing Address - Country:US
Mailing Address - Phone:346-692-8472
Mailing Address - Fax:
Practice Address - Street 1:64 E BROADWAY RD STE 200
Practice Address - Street 2:
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85282-1377
Practice Address - Country:US
Practice Address - Phone:346-500-4514
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-19
Last Update Date:2024-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)