Provider Demographics
NPI:1225790389
Name:LIGHTFOOT, KASSI LEANN (LCSW)
Entity Type:Individual
Prefix:
First Name:KASSI
Middle Name:LEANN
Last Name:LIGHTFOOT
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1042 S IDLEWILD DR
Mailing Address - Street 2:
Mailing Address - City:SHERMAN
Mailing Address - State:TX
Mailing Address - Zip Code:75090-8326
Mailing Address - Country:US
Mailing Address - Phone:903-227-2418
Mailing Address - Fax:
Practice Address - Street 1:1042 S IDLEWILD DR
Practice Address - Street 2:
Practice Address - City:SHERMAN
Practice Address - State:TX
Practice Address - Zip Code:75090-8326
Practice Address - Country:US
Practice Address - Phone:903-227-2418
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-06
Last Update Date:2021-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX652521041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical