Healthcare Provider Details

I. General information

NPI: 1841803475
Provider Name (Legal Business Name): ALEXXANDRIA MARIE MENESES PSY.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/24/2020
Last Update Date: 08/24/2020
Certification Date: 08/24/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4500 S LANCASTER RD
DALLAS TX
75216-7167
US

IV. Provider business mailing address

2944 VACHERIE LN
DALLAS TX
75227-1360
US

V. Phone/Fax

Practice location:
  • Phone: 214-857-0534
  • Fax:
Mailing address:
  • Phone: 209-607-3289
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY-005218
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License NumberPSY-005218
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: