Provider Demographics
NPI:1164317772
Name:AVELAR, ERIC (PPSP)
Entity type:Individual
Prefix:
First Name:ERIC
Middle Name:
Last Name:AVELAR
Suffix:
Gender:M
Credentials:PPSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14265 GRAYVILLE DR
Mailing Address - Street 2:
Mailing Address - City:LA MIRADA
Mailing Address - State:CA
Mailing Address - Zip Code:90638-1930
Mailing Address - Country:US
Mailing Address - Phone:323-459-7808
Mailing Address - Fax:
Practice Address - Street 1:14265 GRAYVILLE DR
Practice Address - Street 2:
Practice Address - City:LA MIRADA
Practice Address - State:CA
Practice Address - Zip Code:90638-1930
Practice Address - Country:US
Practice Address - Phone:323-459-7808
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-12
Last Update Date:2025-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool