Clarissa Breanne Sourada Cannon, M.A., LPC,NCC

Primary specialty

CounselorTaxonomy code 101Y00000X

License

82764 Issued in TX

Practice address

820 16TH St
Galveston, TX 77550-4960

Phone

(760) 504-3099

NPI assigned

May 17, 2022

Last updated

May 17, 2022By the provider in NPPES

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in TX

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Mental Health Counselor

Education

Other, 2019

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Geode Health of Texas, PLLCGroup PAC ID 2062896897, 158 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Arts

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: clarissa.sourada.1@25899.direct.athenahealth.com

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Geode Health of Texas, PLLC

  • Psychiatry Physician
  • Allen, TX
  • NPI 1851037162
  Medicare reassignment Care Compare group NPD
• BSW Geode Clinicians of Texas PLLC

  dba Geode Health 2

  • Psychiatry Physician
  • Allen, TX
  • NPI 1790482834
  Medicare reassignment NPD
• The Resilience Center of Houston, LLC

  dba The Resilience Center of Houston

  • Marriage & Family Therapist
  • Cypress, TX
  • NPI 1821475039
  Medicare reassignment NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1652745600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1652745600000",
    "number": "1538806096",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "820 16TH ST",
            "city": "GALVESTON",
            "state": "TX",
            "postal_code": "775504960",
            "telephone_number": "760-504-3099"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "820 16TH ST",
            "city": "GALVESTON",
            "state": "TX",
            "postal_code": "775504960",
            "telephone_number": "760-504-3099"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SOURADA CANNON",
        "first_name": "CLARISSA",
        "middle_name": "BREANNE",
        "name_prefix": "Ms.",
        "credential": "M.A., LPC,NCC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2022-05-17",
        "last_updated": "2022-05-17",
        "certification_date": "2022-05-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101Y00000X",
            "taxonomy_group": "",
            "desc": "Counselor",
            "state": "TX",
            "license": "82764",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Amanda Song, MD
• Mandi Lynn Sonnenfeld, PHD, OTR/L
• Joseph Sonstein, MD
• Lindsay Kay Sonstein, MD
• Mohamad Khaled Soufi, M.D
• Southwest LTC Gulf Healthcare LTD (Gulf Healthcare Center Galveston)
• Samantha Kay Spears, MD
• Spiritspace, Inc.
• Erin Geordi Sreshta, M.D.
• Sathvik Srikalyani

• Counselor in Galveston, TX
• Providers in Galveston, TX by specialty
• Counselor in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 17, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.