Provider Demographics
NPI:1831429372
Name:AAVERLEE CLINICAL ASSOCIATES
Entity type:Organization
Organization Name:AAVERLEE CLINICAL ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOCIAL WORKER
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:BENEDICT
Authorized Official - Last Name:PFEIFFER
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:361-814-2273
Mailing Address - Street 1:PO BOX 61274
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78466-1274
Mailing Address - Country:US
Mailing Address - Phone:361-814-2273
Mailing Address - Fax:361-814-2274
Practice Address - Street 1:5801 PATTON ST
Practice Address - Street 2:SUITE 100
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78414-2457
Practice Address - Country:US
Practice Address - Phone:361-814-2273
Practice Address - Fax:361-814-2274
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-06
Last Update Date:2010-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX16509101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX119744403Medicaid
TX00S10TMedicare PIN