Provider Demographics
NPI:1194099424
Name:COMPREHNESIVE ASSESSMENT AND COUNSLEING CONNECTIONS
Entity type:Organization
Organization Name:COMPREHNESIVE ASSESSMENT AND COUNSLEING CONNECTIONS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:KASSANDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:HUMPHRESS
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:936-441-3556
Mailing Address - Street 1:100 I 45 N
Mailing Address - Street 2:STE 125A
Mailing Address - City:CONROE
Mailing Address - State:TX
Mailing Address - Zip Code:77301-2890
Mailing Address - Country:US
Mailing Address - Phone:936-441-3556
Mailing Address - Fax:936-756-3555
Practice Address - Street 1:100 I 45 N
Practice Address - Street 2:STE 125A
Practice Address - City:CONROE
Practice Address - State:TX
Practice Address - Zip Code:77301-2890
Practice Address - Country:US
Practice Address - Phone:936-441-3556
Practice Address - Fax:936-756-3555
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-05
Last Update Date:2012-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX65603101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX002856015Medicaid