| Doctor Name: | MARYANNE AVERY |
| NPI Number: | 1215308648 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | MA, CAC III |
| License Number: | 0020794 |
| Business Practice Address: | 1432 Grand Ave Glenwood Springs, CO - 816013808 |
| Business Phone Number: | 1720394986 |
| Business Fax Number: | |
| Mailing Address: | Po Box 4091, FRISCO |
| State: | CO |
| Postal Code: | 804434091 |
| Phone Number: | 7203949869 |
| Fax Number: | |
| NPI Enumeration Date: | 10/12/2015 |
| NPI Last Update Date: | 10/12/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YA0400X |
| License Number: | 0020794 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | CO |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Addiction (Substance Use Disorder) |
| Taxonomy Definition: | |