Provider Demographics
NPI:1861896417
Name:CINCO RANCH BEHAVIORAL HEALTH
Entity type:Organization
Organization Name:CINCO RANCH BEHAVIORAL HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:PHAETRA
Authorized Official - Middle Name:KAFUNYA
Authorized Official - Last Name:RANEY-SEMIEN
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:281-665-7346
Mailing Address - Street 1:24044 CINCO VILLAGE CENTER BLVD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77494-8432
Mailing Address - Country:US
Mailing Address - Phone:281-665-7346
Mailing Address - Fax:
Practice Address - Street 1:24044 CINCO VILLAGE CENTER BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77494-8432
Practice Address - Country:US
Practice Address - Phone:281-665-7346
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-10
Last Update Date:2014-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX25180101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty