Individual
AVERY JOSEPH GEORGE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
2104 GREENBRIAR DR, SOUTHLAKE, TX 76092-8355
(817) 442-9022
(000) 000-0000
Mailing address
1039 FRANKLIN AVE, RIVER FOREST, IL 60305-1339
(224) 240-3096
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
RBT-23-259665
IL
Other
Enumeration date
03/09/2023
Last updated
03/09/2023
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