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General NPI Number Information
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NPI Number | 1487964706
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Entity Type | Individual
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Provider Name | DEVON JAMES SUPERVILLE PHD
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Gender | Male
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Dates
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Enumeration Date | 10/20/2010
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Last Update Date | 07/31/2018
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Provider Practice Location Address
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Address Line | 6201 BONHOMME RD STE 178N
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City | HOUSTON
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State | TX
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Zip | 77036
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Country | US
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Telephone | 281-771-2685
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Fax |
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Provider Business Mailing Address
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Address Line | 3 SUGAR CREEK CENTER BLVD STE. 100
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City | SUGAR LAND
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State | TX
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Zip | 77478-2210
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Country | US
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Telephone | 281-771-2685
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 62990
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 33636
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License Number State | TX
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