Provider Demographics
NPI:1043859762
Name:PUCKETT, CASSIE MAE (LCSW, LCADC)
Entity Type:Individual
Prefix:
First Name:CASSIE
Middle Name:MAE
Last Name:PUCKETT
Suffix:
Gender:F
Credentials:LCSW, LCADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5008 STATE ROUTE 69
Mailing Address - Street 2:
Mailing Address - City:HAWESVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42348-5404
Mailing Address - Country:US
Mailing Address - Phone:270-922-7666
Mailing Address - Fax:
Practice Address - Street 1:1100 WALNUT ST
Practice Address - Street 2:
Practice Address - City:OWENSBORO
Practice Address - State:KY
Practice Address - Zip Code:42301-2956
Practice Address - Country:US
Practice Address - Phone:270-689-6500
Practice Address - Fax:270-689-6677
Is Sole Proprietor?:No
Enumeration Date:2019-12-27
Last Update Date:2024-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY254407104100000X
KY281314101YA0400X
KY2577531041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical