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Organization
MENTAL ASPECTS BEHAVIORAL HEALTH CLINIC
Active
Organization
MENTAL ASPECTS BEHAVIORAL HEALTH CLINIC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RENEE LICORISH APRN (OWNER)
(210) 475-3617
Entity
Organization
Contact information
Practice address
12702 TOEPPERWEIN RD STE 236, LIVE OAK, TX 78233-3231
(210) 475-3617
Mailing address
12702 TOEPPERWEIN RD STE 236, LIVE OAK, TX 78233-3231
(210) 475-3617
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
—
NULL
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
—
—
Other
Enumeration date
12/16/2021
Last updated
12/16/2021
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