Provider Demographics
NPI:1700136561
Name:NEUHAUS, CASSANDRA M (PSYD)
Entity type:Individual
Prefix:DR
First Name:CASSANDRA
Middle Name:M
Last Name:NEUHAUS
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7411 E 126TH CT S
Mailing Address - Street 2:
Mailing Address - City:BIXBY
Mailing Address - State:OK
Mailing Address - Zip Code:74008-2932
Mailing Address - Country:US
Mailing Address - Phone:918-409-0741
Mailing Address - Fax:918-209-5538
Practice Address - Street 1:4815 S HARVARD AVE STE 333
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74135-3077
Practice Address - Country:US
Practice Address - Phone:918-398-3378
Practice Address - Fax:918-209-5538
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-19
Last Update Date:2024-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1227103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200573690AMedicaid