Provider Demographics
NPI:1639764566
Name:KESTERSON, AVERY (LPC-ASSOCIATE)
Entity type:Individual
Prefix:MS
First Name:AVERY
Middle Name:
Last Name:KESTERSON
Suffix:
Gender:F
Credentials:LPC-ASSOCIATE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:552 SILICON DR STE 101
Mailing Address - Street 2:
Mailing Address - City:SOUTHLAKE
Mailing Address - State:TX
Mailing Address - Zip Code:76092-7526
Mailing Address - Country:US
Mailing Address - Phone:972-322-0805
Mailing Address - Fax:
Practice Address - Street 1:552 SILICON DR STE 101
Practice Address - Street 2:
Practice Address - City:SOUTHLAKE
Practice Address - State:TX
Practice Address - Zip Code:76092-7526
Practice Address - Country:US
Practice Address - Phone:972-322-0805
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-03
Last Update Date:2025-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX95323101YP2500X
TXRBT-21-151826106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional