Provider Demographics
NPI:1295089613
Name:MONDRAGON, SASHA (PHD)
Entity type:Individual
Prefix:
First Name:SASHA
Middle Name:
Last Name:MONDRAGON
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4810 W PANTHER CREEK DR STE 100
Mailing Address - Street 2:
Mailing Address - City:SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:77381-5005
Mailing Address - Country:US
Mailing Address - Phone:281-863-9980
Mailing Address - Fax:
Practice Address - Street 1:4810 W PANTHER CREEK DR STE 100
Practice Address - Street 2:
Practice Address - City:SPRING
Practice Address - State:TX
Practice Address - Zip Code:77381-5005
Practice Address - Country:US
Practice Address - Phone:281-863-9980
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-11-07
Last Update Date:2021-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX38490103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical