Provider Demographics
NPI:1124712427
Name:MOLLESON, CASEY L (LCSW)
Entity type:Individual
Prefix:
First Name:CASEY
Middle Name:L
Last Name:MOLLESON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:507 BOULDER RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:DEL RIO
Mailing Address - State:TX
Mailing Address - Zip Code:78840-2162
Mailing Address - Country:US
Mailing Address - Phone:808-381-7640
Mailing Address - Fax:
Practice Address - Street 1:507 BOULDER RIDGE DR
Practice Address - Street 2:
Practice Address - City:DEL RIO
Practice Address - State:TX
Practice Address - Zip Code:78840-2162
Practice Address - Country:US
Practice Address - Phone:808-381-7640
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-08
Last Update Date:2023-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX613411041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical