Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YP1600X | Pastoral Counselor | CS720895 | MS |
NPI | 1275157927 |
---|---|
Provider Name | Dr. Claude Romuald Superville |
First Address | Pearland, TX 77584-3057 |
Second Address | Pearland, TX 77584-3057 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/05/2020 |
Last Update Date | 28/05/2020 |