Provider Demographics
NPI:1235859620
Name:OWEN MATA, CASSIE (CADAC II)
Entity Type:Individual
Prefix:
First Name:CASSIE
Middle Name:
Last Name:OWEN MATA
Suffix:
Gender:F
Credentials:CADAC II
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:115 TANGLEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:SHARPSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46068-9296
Mailing Address - Country:US
Mailing Address - Phone:317-420-1821
Mailing Address - Fax:
Practice Address - Street 1:115 TANGLEWOOD DR
Practice Address - Street 2:
Practice Address - City:SHARPSVILLE
Practice Address - State:IN
Practice Address - Zip Code:46068-9296
Practice Address - Country:US
Practice Address - Phone:317-420-1821
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-29
Last Update Date:2022-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)