MEDICARE: CASSIE DENNIS PHD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106S00000X	Behavior Technician
2	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1366960866
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CASSIE DENNIS PHD

Provider Business Mailing Address
First Line	:	3101 CORDOVA DR
Second Line	:
City	:	TEMPLE
State	:	TX
Zip	:	76502-1666
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1340 PRUDENTIAL DR
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75235-4115
Country	:	US
Telephone Number	:	468-458-0106
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/05/2017
Last Update Date	:	03/02/2025

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Directions to “ CASSIE DENNIS PHD” Practice Location

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