Provider Demographics
NPI:1366974388
Name:CASEY, LOUISE
Entity type:Individual
Prefix:
First Name:LOUISE
Middle Name:
Last Name:CASEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33761 DIANA DR
Mailing Address - Street 2:
Mailing Address - City:DANA POINT
Mailing Address - State:CA
Mailing Address - Zip Code:92629-2308
Mailing Address - Country:US
Mailing Address - Phone:949-400-4048
Mailing Address - Fax:949-209-5824
Practice Address - Street 1:33761 DIANA DR
Practice Address - Street 2:
Practice Address - City:DANA POINT
Practice Address - State:CA
Practice Address - Zip Code:92629-2308
Practice Address - Country:US
Practice Address - Phone:949-400-4048
Practice Address - Fax:949-209-5824
Is Sole Proprietor?:No
Enumeration Date:2017-03-29
Last Update Date:2021-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1-17-335876103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst