Individual
COREY PATRICK PAVELKA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LCSW
Contact information
Practice address
2111 W HIGHWAY 377, GRANBURY, TX 76048-5627
(817) 573-6002
(817) 573-6009
Mailing address
949 SHERRY LN, SAGINAW, TX 76179-0979
(817) 676-2422
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
55382
TX
1041C0700X
Clinical Social Worker
Primary
55382
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
148686201
—
TX
Enumeration date
09/21/2012
Last updated
05/27/2016
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