Provider Demographics
NPI:1992343693
Name:GIOVE, IRIS (PSYD)
Entity type:Individual
Prefix:
First Name:IRIS
Middle Name:
Last Name:GIOVE
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:104 SAN JOSE CT
Mailing Address - Street 2:
Mailing Address - City:SUNLAND PARK
Mailing Address - State:NM
Mailing Address - Zip Code:88063-9077
Mailing Address - Country:US
Mailing Address - Phone:717-434-3455
Mailing Address - Fax:
Practice Address - Street 1:JOHN PETER SMITH HOSPITAL
Practice Address - Street 2:1500 S. MAIN ST.
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104
Practice Address - Country:US
Practice Address - Phone:817-702-4788
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-13
Last Update Date:2019-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX38399103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist