| Doctor Name: | COREY PATRICK PAVELKA |
| NPI Number: | 1225389901 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | LCSW |
| License Number: | 55382 |
| Business Practice Address: | 2111 W Highway 377 Granbury, TX - 760485627 |
| Business Phone Number: | 8175736002 |
| Business Fax Number: | 8175736009 |
| Mailing Address: | 949 Sherry Ln, SAGINAW |
| State: | TX |
| Postal Code: | 761790979 |
| Phone Number: | 8176762422 |
| Fax Number: | |
| NPI Enumeration Date: | 09/21/2012 |
| NPI Last Update Date: | 05/27/2016 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YA0400X |
| License Number: | 55382 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | TX |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Addiction (Substance Use Disorder) |
| Taxonomy Definition: | |