Kentrell Monique Avery, PSY.D.

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

1217 Issued in LA

Practice address

1901 Veterans Memorial Drive
U.S. Department of Veterans Affairs
Temple, TX 76504

Phone

(254) 743-2867

Fax

(254) 743-0304

NPI assigned

Oct 19, 2012

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in LA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Clinical Psychologist

Education

Other, 2009

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Living Well Psychological Services, LLC

  • Clinical Psychologist
  • New Orleans, LA
  • NPI 1710774252
  Medicare reassignment NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1350604800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1381708800000",
    "number": "1265785836",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1901 VETERANS MEMORIAL DRIVE",
            "address_2": "U.S. DEPARTMENT OF VETERANS AFFAIRS",
            "city": "TEMPLE",
            "state": "TX",
            "postal_code": "76504",
            "telephone_number": "254-743-2867",
            "fax_number": "254-743-0304"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1901 VETERANS MEMORIAL DRIVE",
            "address_2": "U.S. DEPARTMENT OF VETERANS AFFAIRS",
            "city": "TEMPLE",
            "state": "TX",
            "postal_code": "76504",
            "telephone_number": "254-743-2867",
            "fax_number": "254-743-0304"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "AVERY",
        "first_name": "KENTRELL",
        "middle_name": "MONIQUE",
        "name_prefix": "Dr.",
        "credential": "PSY.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2012-10-19",
        "last_updated": "2013-10-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "LA",
            "license": "1217",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "N/A",
            "identifier": "N/A",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Tina Aubuchon, CRNA
• Joseph Lewis Austin Sr., PHYSICIAN ASSISANT
• Jude Thaddeus Austin II, PHD, LPC, LMFT-ASSOC
• Richard Chace Auzenne, M.D.
• Kelli Avant
• Ivette Mota Avila, MD
• Andrejs E. Avots-Avotins, M.D.
• Amber Leigh Axline, LMSW
• Jimmy Dean Aycock, D.C.
• Payton Aydelott, DO

• Clinical Psychologist in Temple, TX
• Providers in Temple, TX by specialty
• Clinical Psychologist in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 14, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.