MEDICARE: CATHY LYNN NEVILLE LPC

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	101Y00000X	Counselor	67632	TX

General Provider Information

NPI Number	:	1174863997
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CATHY LYNN NEVILLE LPC

Provider Business Mailing Address
First Line	:	6222 DEZAVALA RD
Second Line	:	SUITE 203
City	:	SAN ANTONIO
State	:	TX
Zip	:	78249-2274
Country	:	US
Telephone Number	:	210-286-0810
Fax Number	:	210-745-4521

Provider Business Practice Location Address
First Line	:	6222 DEZAVALA RD
Second Line	:	SUITE 203
City	:	SAN ANTONIO
State	:	TX
Zip	:	78249-2274
Country	:	US
Telephone Number	:	210-286-0810
Fax Number	:	210-745-4521

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

Provider Enumeration Date	:	02/15/2013
Last Update Date	:	02/15/2013

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