Provider Demographics
NPI:1124689310
Name:AVALOS, JACQUELYN CELENE
Entity type:Individual
Prefix:
First Name:JACQUELYN
Middle Name:CELENE
Last Name:AVALOS
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:JACKIE
Other - Middle Name:
Other - Last Name:AVALOS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:2601 E YANDELL DR STE 118
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79903-3743
Mailing Address - Country:US
Mailing Address - Phone:915-588-4928
Mailing Address - Fax:
Practice Address - Street 1:2601 E YANDELL DR STE 118
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79903-3743
Practice Address - Country:US
Practice Address - Phone:915-588-4928
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-27
Last Update Date:2025-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program