Healthcare Provider Details

I. General information

NPI: 1952154171
Provider Name (Legal Business Name): MRS. CASSANDRA N MENN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/08/2024
Last Update Date: 04/08/2024
Certification Date: 04/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9595 SIX PINES DR FL 2
SPRING TX
77380-1531
US

IV. Provider business mailing address

2106 ROPE MAKER RD
CONROE TX
77384-2510
US

V. Phone/Fax

Practice location:
  • Phone: 713-542-8481
  • Fax:
Mailing address:
  • Phone: 713-542-8481
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number93714
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: