Provider Demographics
NPI:1780397950
Name:PAVON, KEILA
Entity type:Individual
Prefix:
First Name:KEILA
Middle Name:
Last Name:PAVON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5720 BANDERA RD STE 21
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78238-1985
Mailing Address - Country:US
Mailing Address - Phone:210-817-8525
Mailing Address - Fax:210-729-7397
Practice Address - Street 1:5720 BANDERA RD STE 21
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78238-1985
Practice Address - Country:US
Practice Address - Phone:210-817-8525
Practice Address - Fax:210-729-7397
Is Sole Proprietor?:No
Enumeration Date:2023-01-03
Last Update Date:2025-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX8432103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst