Provider Demographics
NPI:1396092474
Name:KASI, IRYNA (PHD)
Entity type:Individual
Prefix:DR
First Name:IRYNA
Middle Name:
Last Name:KASI
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2640 APPLE BLOSSOM LN
Mailing Address - Street 2:
Mailing Address - City:CONWAY
Mailing Address - State:AR
Mailing Address - Zip Code:72034-8490
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1210 HOGAN LN
Practice Address - Street 2:SUITE 200
Practice Address - City:CONWAY
Practice Address - State:AR
Practice Address - Zip Code:72034-8001
Practice Address - Country:US
Practice Address - Phone:501-932-0255
Practice Address - Fax:501-932-0258
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-08
Last Update Date:2012-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR12-04AP-PL103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist