Provider Demographics
NPI:1922734284
Name:PAVON, CARLOS (LMSW)
Entity type:Individual
Prefix:
First Name:CARLOS
Middle Name:
Last Name:PAVON
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6707 CYPRESS GLADES DR
Mailing Address - Street 2:
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77449-4379
Mailing Address - Country:US
Mailing Address - Phone:713-345-0929
Mailing Address - Fax:
Practice Address - Street 1:4009 BANISTER LN STE 200
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78704-7056
Practice Address - Country:US
Practice Address - Phone:512-508-8269
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-28
Last Update Date:2024-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1082111041C0700X
NMSWB-2022-04391041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical