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General NPI Number Information
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NPI Number | 1245182658
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Entity Type | Individual
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Provider Name | JENNA TANIS MASOUD BA
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Gender | Female
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Dates
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Enumeration Date | 02/10/2026
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Last Update Date | 02/10/2026
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Provider Practice Location Address
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Address Line | 121 VISION PARK BLVD STE 120
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City | SHENANDOAH
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State | TX
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Zip | 77384-3027
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Country | US
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Telephone | 346-678-4626
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Fax | 346-678-4626
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Provider Business Mailing Address
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Address Line | 130 S SAWBRIDGE CIR
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City | THE WOODLANDS
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State | TX
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Zip | 77389-5142
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Country | US
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Telephone | 346-678-4626
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number |
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License Number State | TX
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