Provider Demographics
NPI:1669886032
Name:FELISE DE NOVO, PC
Entity type:Organization
Organization Name:FELISE DE NOVO, PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:FELISE
Authorized Official - Middle Name:
Authorized Official - Last Name:DE NOVO
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:210-419-3923
Mailing Address - Street 1:P. O. BOX 12851
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78212
Mailing Address - Country:US
Mailing Address - Phone:210-419-3923
Mailing Address - Fax:210-320-0958
Practice Address - Street 1:2400 MCCULLOUGH AVE.
Practice Address - Street 2:#12851
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78212
Practice Address - Country:US
Practice Address - Phone:210-419-3923
Practice Address - Fax:210-320-0958
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-13
Last Update Date:2014-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX16133101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1164638011OtherNPI
TX029050402Medicaid
TX1386723500OtherNPI