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General NPI Number Information
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NPI Number | 1649959818
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Entity Type | Organization
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Legal Business Name | INNOVA MIND AND BODY
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Dates
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Enumeration Date | 07/14/2023
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Last Update Date | 11/29/2024
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Provider Practice Location Address
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Address Line | 16712 HUFFMEISTER RD STE 400A
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City | CYPRESS
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State | TX
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Zip | 77429-8695
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Country | US
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Telephone | 832-850-3110
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Fax | 832-850-3112
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Provider Business Mailing Address
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Address Line | 16712 HUFFMEISTER RD STE 400A
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City | CYPRESS
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State | TX
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Zip | 77429-8695
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Country | US
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Telephone | 832-850-3110
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Fax | 832-850-3112
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Authorized Official
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Title or Position | OWNER
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Name | ALICIA SANDOVAL-ALEXANDER
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Credential | NP
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Telephone | 832-250-3746
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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