Provider Demographics
NPI:1487964706
Name:SUPERVILLE, DEVON JAMES (PHD)
Entity type:Individual
Prefix:
First Name:DEVON
Middle Name:JAMES
Last Name:SUPERVILLE
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 SUGAR CREEK CENTER BLVD
Mailing Address - Street 2:STE. 100
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77478-2210
Mailing Address - Country:US
Mailing Address - Phone:281-771-2685
Mailing Address - Fax:
Practice Address - Street 1:6201 BONHOMME RD STE 178N
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77036
Practice Address - Country:US
Practice Address - Phone:281-771-2685
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-20
Last Update Date:2018-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX62990101YP2500X
TX33636103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional