Provider Demographics
NPI:1861894636
Name:AVIRETT, ERIN (PHD)
Entity type:Individual
Prefix:
First Name:ERIN
Middle Name:
Last Name:AVIRETT
Suffix:
Gender:F
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:PO BOX 20260
Mailing Address - Street 2:
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79114-2260
Mailing Address - Country:US
Mailing Address - Phone:806-513-2008
Mailing Address - Fax:
Practice Address - Street 1:1619 S KENTUCKY ST STE A510
Practice Address - Street 2:
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79102-2291
Practice Address - Country:US
Practice Address - Phone:806-513-2008
Practice Address - Fax:806-410-1669
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-23
Last Update Date:2024-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX36755103TC2200X, 103T00000X
TX70120103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
No103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool