Provider Demographics
NPI:1023763786
Name:CASEY COURSEY LCSW EMDR
Entity type:Organization
Organization Name:CASEY COURSEY LCSW EMDR
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CASEY
Authorized Official - Middle Name:
Authorized Official - Last Name:CASSETTY
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:364-203-8188
Mailing Address - Street 1:410 E 10TH AVE # 2C
Mailing Address - Street 2:
Mailing Address - City:BOWLING GREEN
Mailing Address - State:KY
Mailing Address - Zip Code:42101-2212
Mailing Address - Country:US
Mailing Address - Phone:364-203-8188
Mailing Address - Fax:949-437-3743
Practice Address - Street 1:410 E 10TH AVE # 2C
Practice Address - Street 2:
Practice Address - City:BOWLING GREEN
Practice Address - State:KY
Practice Address - Zip Code:42101-2212
Practice Address - Country:US
Practice Address - Phone:364-203-8188
Practice Address - Fax:949-437-3743
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-21
Last Update Date:2022-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TP2701XBehavioral Health & Social Service ProvidersPsychologistGroup PsychotherapyGroup - Multi-Specialty