Provider Demographics
NPI:1356489108
Name:DUTY, CASEY W (LPC)
Entity Type:Individual
Prefix:
First Name:CASEY
Middle Name:W
Last Name:DUTY
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4352 EMMETT F LOWRY EXPY
Mailing Address - Street 2:
Mailing Address - City:TEXAS CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77591-2628
Mailing Address - Country:US
Mailing Address - Phone:409-763-2373
Mailing Address - Fax:
Practice Address - Street 1:4444 W MAIN ST
Practice Address - Street 2:
Practice Address - City:LEAGUE CITY
Practice Address - State:TX
Practice Address - Zip Code:77573-1737
Practice Address - Country:US
Practice Address - Phone:281-585-7464
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-02
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX16056101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor