Provider Demographics
NPI:1164973673
Name:THE MENNINGER CLINIC
Entity Type:Organization
Organization Name:THE MENNINGER CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:STAFF THERAPIST INTERN
Authorized Official - Prefix:MISS
Authorized Official - First Name:CZARINA
Authorized Official - Middle Name:V
Authorized Official - Last Name:AZZAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:832-881-8990
Mailing Address - Street 1:2408 YORKTOWN ST
Mailing Address - Street 2:APT. 234
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77056-4573
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:12301 MAIN ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77035-6207
Practice Address - Country:US
Practice Address - Phone:713-275-5000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-19
Last Update Date:2016-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX76606283Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes283Q00000XHospitalsPsychiatric Hospital