Provider Demographics
NPI:1649828435
Name:AVERY, PASCHA (LMHC)
Entity type:Individual
Prefix:
First Name:PASCHA
Middle Name:
Last Name:AVERY
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:PASCHA
Other - Middle Name:
Other - Last Name:WINTERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:230 BENNETT AVE
Mailing Address - Street 2:
Mailing Address - City:HURLBURT FIELD
Mailing Address - State:FL
Mailing Address - Zip Code:32544-5706
Mailing Address - Country:US
Mailing Address - Phone:850-884-7965
Mailing Address - Fax:
Practice Address - Street 1:230 BENNETT AVE
Practice Address - Street 2:
Practice Address - City:HURLBURT FIELD
Practice Address - State:FL
Practice Address - Zip Code:32544-5706
Practice Address - Country:US
Practice Address - Phone:850-884-7965
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-27
Last Update Date:2024-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH17167101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health