Provider Demographics
NPI:1720654551
Name:CAVAZOS, JOSE ADRIAN
Entity Type:Individual
Prefix:
First Name:JOSE
Middle Name:ADRIAN
Last Name:CAVAZOS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2825 VALLEY VIEW LN STE 100
Mailing Address - Street 2:
Mailing Address - City:FARMERS BRANCH
Mailing Address - State:TX
Mailing Address - Zip Code:75234-4943
Mailing Address - Country:US
Mailing Address - Phone:214-736-8376
Mailing Address - Fax:214-377-4942
Practice Address - Street 1:2825 VALLEY VIEW LN STE 100
Practice Address - Street 2:
Practice Address - City:FARMERS BRANCH
Practice Address - State:TX
Practice Address - Zip Code:75234-4943
Practice Address - Country:US
Practice Address - Phone:214-736-8376
Practice Address - Fax:214-377-4942
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-02
Last Update Date:2021-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX20-13664106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician