Provider Demographics
NPI:1154750495
Name:TANI-PRADO, SOPHIA (PHD)
Entity type:Individual
Prefix:DR
First Name:SOPHIA
Middle Name:
Last Name:TANI-PRADO
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:SOPHIA
Other - Middle Name:
Other - Last Name:TANI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3730 KIRBY DR
Mailing Address - Street 2:SUITE 800
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77098-3905
Mailing Address - Country:US
Mailing Address - Phone:713-521-7575
Mailing Address - Fax:713-521-7576
Practice Address - Street 1:3730 KIRBY DR
Practice Address - Street 2:SUITE 800
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77098-3905
Practice Address - Country:US
Practice Address - Phone:713-521-7575
Practice Address - Fax:713-521-7576
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-07
Last Update Date:2014-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX36167103T00000X
TX35123103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool