Provider Demographics
NPI:1831414408
Name:NEISS, TREVA L (LCSW)
Entity type:Individual
Prefix:MS
First Name:TREVA
Middle Name:L
Last Name:NEISS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4201 MEDICAL DR
Mailing Address - Street 2:SUITE 280
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229-5656
Mailing Address - Country:US
Mailing Address - Phone:210-616-9915
Mailing Address - Fax:210-616-9710
Practice Address - Street 1:4201 MEDICAL DR
Practice Address - Street 2:SUITE 280
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-5656
Practice Address - Country:US
Practice Address - Phone:210-616-9915
Practice Address - Fax:210-616-9710
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-07
Last Update Date:2010-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXSO9757101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional