Provider Demographics
NPI:1598377210
Name:AVERA, KODI CARROLL
Entity type:Individual
Prefix:
First Name:KODI
Middle Name:CARROLL
Last Name:AVERA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:206 GROVE PL
Mailing Address - Street 2:
Mailing Address - City:CIBOLO
Mailing Address - State:TX
Mailing Address - Zip Code:78108-3413
Mailing Address - Country:US
Mailing Address - Phone:682-367-7341
Mailing Address - Fax:
Practice Address - Street 1:790 GENERATIONS DR STE 410
Practice Address - Street 2:
Practice Address - City:NEW BRAUNFELS
Practice Address - State:TX
Practice Address - Zip Code:78130-6720
Practice Address - Country:US
Practice Address - Phone:830-625-0599
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-24
Last Update Date:2025-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1164051041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical