Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101YA0400X | Addiction Counselor (Substance Use Disorder) | A5630611 | CA |
N | 101YM0800X | Mental Health Counselor |
NPI | 1003059387 |
---|---|
Provider Name | Jeffrey Alan Avants |
First Address | Simi Valley, CA 93065-3940 |
Second Address | Simi Valley, CA 93065-3940 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/04/2009 |
Last Update Date | 08/03/2013 |