Provider Demographics
NPI:1063877538
Name:CND THERAPY PLLC
Entity type:Organization
Organization Name:CND THERAPY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CONCEPCION
Authorized Official - Middle Name:MATA
Authorized Official - Last Name:ANDRIJESKI
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:682-203-7096
Mailing Address - Street 1:602 STRADA CIR
Mailing Address - Street 2:SUITE 112
Mailing Address - City:MANSFIELD
Mailing Address - State:TX
Mailing Address - Zip Code:76063-3201
Mailing Address - Country:US
Mailing Address - Phone:682-203-7096
Mailing Address - Fax:817-730-9314
Practice Address - Street 1:602 STRADA CIR
Practice Address - Street 2:SUITE 112
Practice Address - City:MANSFIELD
Practice Address - State:TX
Practice Address - Zip Code:76063-3201
Practice Address - Country:US
Practice Address - Phone:682-203-7096
Practice Address - Fax:817-730-9314
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-28
Last Update Date:2015-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX17140251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health