Provider Demographics
NPI:1043423494
Name:CASEY, MARK KEKOA (LCSW)
Entity Type:Individual
Prefix:MR
First Name:MARK
Middle Name:KEKOA
Last Name:CASEY
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:220 S. 3RD PLACE
Mailing Address - Street 2:
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98057-2494
Mailing Address - Country:US
Mailing Address - Phone:425-228-0074
Mailing Address - Fax:
Practice Address - Street 1:220 S. 3RD PLACE
Practice Address - Street 2:
Practice Address - City:RENTON
Practice Address - State:WA
Practice Address - Zip Code:98057-2494
Practice Address - Country:US
Practice Address - Phone:425-228-0074
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-08
Last Update Date:2011-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK27951041C0700X
AR1797-C1041C0700X
MO20040114631041C0700X
FLSW 61861041C0700X
WALW 000095761041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical