Provider Demographics
NPI:1700506490
Name:AYALA, JOE MICHAEL (PHD)
Entity type:Individual
Prefix:DR
First Name:JOE
Middle Name:MICHAEL
Last Name:AYALA
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3210 WOOD CREEK DR
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78410-5793
Mailing Address - Country:US
Mailing Address - Phone:361-438-7872
Mailing Address - Fax:
Practice Address - Street 1:3210 WOOD CREEK DR
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78410-5793
Practice Address - Country:US
Practice Address - Phone:361-438-7872
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-01
Last Update Date:2022-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX84347101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health