Provider Demographics
NPI:1154437192
Name:CAYCE, MARY KATHERINE (LPC)
Entity type:Individual
Prefix:MRS
First Name:MARY KATHERINE
Middle Name:
Last Name:CAYCE
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5117 GULFWIND LN
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76123-1937
Mailing Address - Country:US
Mailing Address - Phone:817-707-6059
Mailing Address - Fax:
Practice Address - Street 1:5117 GULFWIND LN
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76123-1937
Practice Address - Country:US
Practice Address - Phone:817-707-6059
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-22
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX17398101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional