Provider Demographics
NPI:1932348018
Name:AVALON CENTER
Entity Type:Organization
Organization Name:AVALON CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:LORETTA
Authorized Official - Middle Name:
Authorized Official - Last Name:PAYNE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:254-859-5990
Mailing Address - Street 1:480 HIGHWAY 7
Mailing Address - Street 2:
Mailing Address - City:EDDY
Mailing Address - State:TX
Mailing Address - Zip Code:76524-2448
Mailing Address - Country:US
Mailing Address - Phone:254-859-5990
Mailing Address - Fax:254-859-5188
Practice Address - Street 1:480 HIGHWAY 7
Practice Address - Street 2:
Practice Address - City:EDDY
Practice Address - State:TX
Practice Address - Zip Code:76524-2448
Practice Address - Country:US
Practice Address - Phone:254-859-5990
Practice Address - Fax:254-859-5188
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-12
Last Update Date:2009-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX172232401101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty