MEDICARE: MS. TREVA L. NEISS LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	SO9757	TX

General Provider Information

NPI Number	:	1831414408
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. TREVA L. NEISS LCSW

Provider Business Mailing Address
First Line	:	4201 MEDICAL DR
Second Line	:	SUITE 280
City	:	SAN ANTONIO
State	:	TX
Zip	:	78229-5656
Country	:	US
Telephone Number	:	210-616-9915
Fax Number	:	210-616-9710

Provider Business Practice Location Address
First Line	:	4201 MEDICAL DR
Second Line	:	SUITE 280
City	:	SAN ANTONIO
State	:	TX
Zip	:	78229-5656
Country	:	US
Telephone Number	:	210-616-9915
Fax Number	:	210-616-9710

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/07/2010
Last Update Date	:	04/07/2010

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