Provider Demographics
NPI:1700240702
Name:PROULX, AVA
Entity type:Individual
Prefix:
First Name:AVA
Middle Name:
Last Name:PROULX
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:AVA
Other - Middle Name:M
Other - Last Name:TODD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BS
Mailing Address - Street 1:1931 JILL AVE
Mailing Address - Street 2:
Mailing Address - City:PAHRUMP
Mailing Address - State:NV
Mailing Address - Zip Code:89060-3609
Mailing Address - Country:US
Mailing Address - Phone:315-427-5604
Mailing Address - Fax:
Practice Address - Street 1:1931 JILL AVE
Practice Address - Street 2:
Practice Address - City:PAHRUMP
Practice Address - State:NV
Practice Address - Zip Code:89060-3609
Practice Address - Country:US
Practice Address - Phone:315-427-5604
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-04-06
Last Update Date:2016-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker