Healthcare Provider Details

I. General information

NPI: 1023744315
Provider Name (Legal Business Name): INNOVA RECOVERY, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/28/2022
Last Update Date: 05/10/2023
Certification Date: 05/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2827 N DAL PASO ST STE 113
HOBBS NM
88240-2062
US

IV. Provider business mailing address

1842 LOCKHILL SELMA RD
SAN ANTONIO TX
78213-1559
US

V. Phone/Fax

Practice location:
  • Phone: 210-254-3618
  • Fax: 210-881-9022
Mailing address:
  • Phone: 210-838-0090
  • Fax: 210-881-9022

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: KASI HOWARD
Title or Position: OWNER
Credential: PSYD
Phone: 210-254-3618