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General NPI Number Information
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NPI Number | 1023627304
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Entity Type | Organization
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Legal Business Name | DENOVO THERAPY LLC
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Dates
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Enumeration Date | 07/23/2020
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Last Update Date | 12/09/2020
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Provider Practice Location Address
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Address Line | 2345 50TH ST STE 501
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City | LUBBOCK
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State | TX
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Zip | 79412-2565
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Country | US
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Telephone | 806-370-3157
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Fax | 806-243-4002
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Provider Business Mailing Address
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Address Line | 6803 INDIANA AVE
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City | LUBBOCK
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State | TX
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Zip | 79413-6109
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Country | US
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Telephone | 806-370-3157
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Fax | 806-243-4002
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Authorized Official
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Title or Position | DIRECTOR
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Name | BENJAMIN MCCAULEY
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Credential |
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Telephone | 806-370-3157
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number |
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License Number State |
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