Provider Demographics
NPI:1356904973
Name:RUNAAS, CANDACE (LMFT SUPERVISOR)
Entity type:Individual
Prefix:
First Name:CANDACE
Middle Name:
Last Name:RUNAAS
Suffix:
Gender:F
Credentials:LMFT SUPERVISOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15555 KUYKENDAHL RD STE 318A
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77090-3651
Mailing Address - Country:US
Mailing Address - Phone:832-224-3436
Mailing Address - Fax:
Practice Address - Street 1:15555 KUYKENDAHL RD STE 318A
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77090-3651
Practice Address - Country:US
Practice Address - Phone:832-224-3436
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-18
Last Update Date:2020-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX203065106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist