Provider Demographics
NPI:1104101773
Name:CASSADY, KELLY (LMFT)
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:
Last Name:CASSADY
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10451 W PALMERAS DR
Mailing Address - Street 2:SUITE 221 E
Mailing Address - City:SUN CITY
Mailing Address - State:AZ
Mailing Address - Zip Code:85373-2011
Mailing Address - Country:US
Mailing Address - Phone:623-293-8527
Mailing Address - Fax:
Practice Address - Street 1:10451 W PALMERAS DR
Practice Address - Street 2:SUITE 221 E
Practice Address - City:SUN CITY
Practice Address - State:AZ
Practice Address - Zip Code:85373-2011
Practice Address - Country:US
Practice Address - Phone:623-293-8527
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-14
Last Update Date:2011-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ10235106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist