Provider Demographics
NPI:1497598684
Name:INNOVA RECOVERY, PLLC
Entity type:Organization
Organization Name:INNOVA RECOVERY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KASI
Authorized Official - Middle Name:
Authorized Official - Last Name:HOWARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:210-254-3618
Mailing Address - Street 1:3502 PAESANOS PKWY STE 101
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78231-1297
Mailing Address - Country:US
Mailing Address - Phone:210-254-3618
Mailing Address - Fax:
Practice Address - Street 1:2524 N BROADWAY # 563
Practice Address - Street 2:
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73034-4172
Practice Address - Country:US
Practice Address - Phone:210-254-3618
Practice Address - Fax:210-881-9022
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-06-15
Last Update Date:2024-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty