Provider Demographics
NPI:1275029357
Name:HENRIQUES, CASSIDY (LMFT)
Entity type:Individual
Prefix:
First Name:CASSIDY
Middle Name:
Last Name:HENRIQUES
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 HEATHER LN APT 8
Mailing Address - Street 2:
Mailing Address - City:MANKATO
Mailing Address - State:MN
Mailing Address - Zip Code:56001-5690
Mailing Address - Country:US
Mailing Address - Phone:763-412-5463
Mailing Address - Fax:
Practice Address - Street 1:201 N BROAD ST STE 200
Practice Address - Street 2:
Practice Address - City:MANKATO
Practice Address - State:MN
Practice Address - Zip Code:56001-3569
Practice Address - Country:US
Practice Address - Phone:507-200-2624
Practice Address - Fax:507-225-1501
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-02
Last Update Date:2024-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT119421173902106H00000X
106S00000X
MN4691106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician