Pavelka, Corey Patrick

Pavelka, Corey Patrick is an sole proprietor health care provider with primary practice located at 2111 W Highway 377 , Granbury TX 76048-5627. He recently has 2 registered licenses in different health care specialties including Behavioral Health & Social Service Providers / Addiction (Substance Use Disorder), Behavioral Health & Social Service Providers / Clinical. Behavioral Health & Social Service Providers / Clinical is his primary health care specialty. Pavelka, Corey Patrick can be contacted via phone (817) 573-6002.

Contact Information

Primary practice address
2111 W Highway 377 Granbury TX 76048-5627
Phone: (817) 573-6002
Fax: (817) 573-6009
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Addiction (Substance Use Disorder) 101YA0400X 55382 Texas
Behavioral Health & Social Service Providers / Clinical 1041C0700X 55382 Texas

Profile Details

NPI number 1225389901
LBN Legal business name Pavelka, Corey Patrick
Credentials Licensed Clinical Social Worker (LCSW)
Entity Individual
Sole proprietor 1 Yes
Enumeration date Sep 21st, 2012
Last updated May 27th, 2016 - about 9 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1225389901 NPPES
Texas MEDICAID 148686201

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