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General NPI Number Information
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NPI Number | 1295089613
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Entity Type | Individual
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Provider Name | SASHA MONDRAGON PHD
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Gender | Female
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Dates
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Enumeration Date | 11/07/2012
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Last Update Date | 07/22/2021
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Provider Practice Location Address
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Address Line | 4810 W PANTHER CREEK DR STE 100
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City | SPRING
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State | TX
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Zip | 77381-5005
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Country | US
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Telephone | 281-863-9980
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Fax |
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Provider Business Mailing Address
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Address Line | 4810 W PANTHER CREEK DR STE 100
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City | SPRING
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State | TX
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Zip | 77381-5005
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Country | US
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Telephone | 281-863-9980
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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 | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 38490
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License Number State | TX
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