Provider Demographics
NPI:1700126117
Name:AVILA, ALEXANDER ANTHONY (MA)
Entity Type:Individual
Prefix:
First Name:ALEXANDER
Middle Name:ANTHONY
Last Name:AVILA
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7921 SOUTHPARK PLZ
Mailing Address - Street 2:SUITE 204
Mailing Address - City:LITTLETON
Mailing Address - State:CO
Mailing Address - Zip Code:80120-5630
Mailing Address - Country:US
Mailing Address - Phone:720-489-8555
Mailing Address - Fax:720-489-8304
Practice Address - Street 1:7921 SOUTHPARK PLZ
Practice Address - Street 2:SUITE 204
Practice Address - City:LITTLETON
Practice Address - State:CO
Practice Address - Zip Code:80120-5630
Practice Address - Country:US
Practice Address - Phone:720-489-8555
Practice Address - Fax:720-489-8304
Is Sole Proprietor?:No
Enumeration Date:2013-02-21
Last Update Date:2013-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CONLC0011263101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional