Provider Demographics
NPI:1902132798
Name:CLANSY, CHERYL D
Entity Type:Individual
Prefix:DR
First Name:CHERYL
Middle Name:D
Last Name:CLANSY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2619 DOUBLE LAKE DR
Mailing Address - Street 2:
Mailing Address - City:MISSOURI CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77459-3903
Mailing Address - Country:US
Mailing Address - Phone:903-926-0662
Mailing Address - Fax:
Practice Address - Street 1:8303 SOUTHWEST FWY
Practice Address - Street 2:SUITE 640
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77074-1600
Practice Address - Country:US
Practice Address - Phone:713-777-8633
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-28
Last Update Date:2016-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX58768101Y00000X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor