Healthcare Provider Details

I. General information

NPI: 1487616561
Provider Name (Legal Business Name): CYNTHIA ANNE CLAASSEN PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/05/2006
Last Update Date: 11/08/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1617 HEMPHILL ST
FORT WORTH TX
76104
US

IV. Provider business mailing address

PO BOX 732973
DALLAS TX
75373-2973
US

V. Phone/Fax

Practice location:
  • Phone: 817-702-3100
  • Fax: 817-702-4847
Mailing address:
  • Phone: 817-702-8450
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number25805
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: