Provider Demographics
NPI:1275157927
Name:SUPERVILLE, CLAUDE ROMUALD (PHD, THD, DBC)
Entity Type:Individual
Prefix:DR
First Name:CLAUDE
Middle Name:ROMUALD
Last Name:SUPERVILLE
Suffix:
Gender:M
Credentials:PHD, THD, DBC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9718 BERKSHIRE TRCE
Mailing Address - Street 2:
Mailing Address - City:PEARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:77584-3057
Mailing Address - Country:US
Mailing Address - Phone:832-654-9668
Mailing Address - Fax:
Practice Address - Street 1:9718 BERKSHIRE TRCE
Practice Address - Street 2:
Practice Address - City:PEARLAND
Practice Address - State:TX
Practice Address - Zip Code:77584-3057
Practice Address - Country:US
Practice Address - Phone:832-654-9668
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-28
Last Update Date:2020-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSCS720895101YP1600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral