Provider Demographics
NPI:1245792217
Name:HENNEKE, CASEY (MA)
Entity Type:Individual
Prefix:
First Name:CASEY
Middle Name:
Last Name:HENNEKE
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:190 DONDO LN
Mailing Address - Street 2:
Mailing Address - City:GOLIAD
Mailing Address - State:TX
Mailing Address - Zip Code:77963-3210
Mailing Address - Country:US
Mailing Address - Phone:361-645-0245
Mailing Address - Fax:
Practice Address - Street 1:1402 VILLAGE DR STE A
Practice Address - Street 2:
Practice Address - City:VICTORIA
Practice Address - State:TX
Practice Address - Zip Code:77901-4157
Practice Address - Country:US
Practice Address - Phone:361-645-0245
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-01
Last Update Date:2019-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health