Provider Demographics
NPI:1154462349
Name:SOVA-ROBERTSON, SUZETTE M (LPC)
Entity Type:Individual
Prefix:
First Name:SUZETTE
Middle Name:M
Last Name:SOVA-ROBERTSON
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10004 WURZBACH RD # 225
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78230-2214
Mailing Address - Country:US
Mailing Address - Phone:512-730-0229
Mailing Address - Fax:
Practice Address - Street 1:18707 HARDY OAK BLVD STE 410
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78258-4841
Practice Address - Country:US
Practice Address - Phone:210-503-1729
Practice Address - Fax:855-420-6402
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-09
Last Update Date:2023-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX61164101Y00000X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX186073601Medicaid