Provider Demographics
NPI:1548251440
Name:AVERY, JEAN MIELKE (MA LPC NCC)
Entity type:Individual
Prefix:MS
First Name:JEAN
Middle Name:MIELKE
Last Name:AVERY
Suffix:
Gender:F
Credentials:MA LPC NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2222 WEST SPRING CREEK PKWY #215
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75023
Mailing Address - Country:US
Mailing Address - Phone:972-964-3214
Mailing Address - Fax:972-964-3044
Practice Address - Street 1:2222 WEST SPRING CREEK PKWY #215
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75023
Practice Address - Country:US
Practice Address - Phone:972-964-3214
Practice Address - Fax:972-964-3044
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX16728101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional