Provider Demographics
NPI:1699932723
Name:MAYA, GENEVA (LCSW)
Entity type:Individual
Prefix:
First Name:GENEVA
Middle Name:
Last Name:MAYA
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 841969
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75284-1969
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4410 NAVIGATION BLVD
Practice Address - Street 2:SUITE 278
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77011-1036
Practice Address - Country:US
Practice Address - Phone:713-547-8282
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-16
Last Update Date:2008-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX22005104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker