Basic Information
| Provider Information | |||||||||
| NPI: | 1972873677 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MENASSA | ||||||||
| FirstName: | BRET | ||||||||
| MiddleName: | MICHAEL | ||||||||
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| Credential: | PHD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8200 WALNUT HILL LN | ||||||||
| Address2: | DEPARTMENT OF PSYCHIATRY | ||||||||
| City: | DALLAS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 752314426 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2143457355 | ||||||||
| FaxNumber: | 2143458753 | ||||||||
| Practice Location | |||||||||
| Address1: | 8200 WALNUT HILL LN | ||||||||
| Address2: | DEPARTMENT OF PSYCHIATRY | ||||||||
| City: | DALLAS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 752314426 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2143457355 | ||||||||
| FaxNumber: | 2143458753 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/11/2012 | ||||||||
| LastUpdateDate: | 03/22/2013 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YP2500X | 62463 | TX | Y | Behavioral Health & Social Service Providers | Counselor | Professional |
No ID Information.