Provider Demographics
NPI:1427425404
Name:CASEY, KATHRYN (LPC, JD)
Entity type:Individual
Prefix:
First Name:KATHRYN
Middle Name:
Last Name:CASEY
Suffix:
Gender:F
Credentials:LPC, JD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8528 DAVIS BLVD
Mailing Address - Street 2:SUITE 134 #228
Mailing Address - City:NORTH RICHLAND HILLS
Mailing Address - State:TX
Mailing Address - Zip Code:76182-8367
Mailing Address - Country:US
Mailing Address - Phone:817-881-1914
Mailing Address - Fax:
Practice Address - Street 1:270 MIRON DR
Practice Address - Street 2:SUITE 112
Practice Address - City:SOUTHLAKE
Practice Address - State:TX
Practice Address - Zip Code:76092-7856
Practice Address - Country:US
Practice Address - Phone:817-881-1914
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-26
Last Update Date:2015-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX71471101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional