Provider Demographics
NPI:1831197482
Name:SAPP, AIDA JANET (PHD, PMHCNS/NP, LMFT)
Entity type:Individual
Prefix:DR
First Name:AIDA
Middle Name:JANET
Last Name:SAPP
Suffix:
Gender:F
Credentials:PHD, PMHCNS/NP, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 844658
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75284-4658
Mailing Address - Country:US
Mailing Address - Phone:800-994-0371
Mailing Address - Fax:254-774-9672
Practice Address - Street 1:200 W CALHOUN AVE
Practice Address - Street 2:
Practice Address - City:TEMPLE
Practice Address - State:TX
Practice Address - Zip Code:76501-3127
Practice Address - Country:US
Practice Address - Phone:254-774-8806
Practice Address - Fax:254-774-9672
Is Sole Proprietor?:No
Enumeration Date:2005-07-08
Last Update Date:2020-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX003310-041463106H00000X
TXAP104373364SP0809X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No364SP0809XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Adult
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8287BHOtherBCBS
TX8287BHOtherBCBS