Provider Demographics
NPI:1134276322
Name:NOVELLINO, GINA RENEE (PHD)
Entity type:Individual
Prefix:DR
First Name:GINA
Middle Name:RENEE
Last Name:NOVELLINO
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3707 FM 1960 RD W
Mailing Address - Street 2:SUITE 245
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77068-3526
Mailing Address - Country:US
Mailing Address - Phone:281-866-9599
Mailing Address - Fax:281-866-9588
Practice Address - Street 1:3707 FM 1960 RD W
Practice Address - Street 2:SUITE 245
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77068-3526
Practice Address - Country:US
Practice Address - Phone:281-866-9599
Practice Address - Fax:281-866-9588
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX23792103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist