Provider Demographics
NPI:1720143225
Name:SADRE, MAHNAZ (MS)
Entity Type:Individual
Prefix:MS
First Name:MAHNAZ
Middle Name:
Last Name:SADRE
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3321 SOMERSET LN
Mailing Address - Street 2:
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75033-1106
Mailing Address - Country:US
Mailing Address - Phone:214-995-0007
Mailing Address - Fax:972-625-9911
Practice Address - Street 1:3550 PARKWOOD BLVD
Practice Address - Street 2:SUITE A 201
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75034-1903
Practice Address - Country:US
Practice Address - Phone:214-618-6888
Practice Address - Fax:972-625-9911
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-26
Last Update Date:2017-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX16459101YP2500X
TX4943106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX562533240OtherTAX ID NUMBER