Active NPI
Jeronimo Bolivar Aviles, LPC
- Professional Counselor
- Bedford, TX
National Provider Identifier
1942471412
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- 59034
- Practice address
- 3800 Victoria CT
Bedford, TX 76021-6159 - Phone
- (817) 881-5883
- Fax
- (817) 624-7425
- NPI assigned
- Mar 12, 2008
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | 59034 | TX | Primary |
Addresses
Primary practice location
3800 Victoria CT
Bedford, TX 76021-6159
Mailing address
4755 North Fwy
Fort Worth, TX 76106-2315
Phone (817) 881-5883
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 59034 | TX | MD | Professional Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1205280000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1205280000000",
"number": "1942471412",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4755 NORTH FWY",
"city": "FORT WORTH",
"state": "TX",
"postal_code": "761062315",
"telephone_number": "817-881-5883",
"fax_number": "817-358-0323"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3800 VICTORIA CT",
"city": "BEDFORD",
"state": "TX",
"postal_code": "760216159",
"telephone_number": "817-881-5883",
"fax_number": "817-624-7425"
}
],
"practiceLocations": [],
"basic": {
"last_name": "AVILES",
"first_name": "JERONIMO",
"middle_name": "BOLIVAR",
"name_prefix": "Mr.",
"credential": "LPC",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2008-03-12",
"last_updated": "2008-03-12",
"status": "A"
},
"taxonomies": [
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "TX",
"license": "59034",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Bedford, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 12, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.