Provider Demographics
NPI:1396022414
Name:CALL, CASEY DIANE (MS, MED, LPC)
Entity Type:Individual
Prefix:MRS
First Name:CASEY
Middle Name:DIANE
Last Name:CALL
Suffix:
Gender:F
Credentials:MS, MED, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1401 LIPSCOMB ST
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76104-4756
Mailing Address - Country:US
Mailing Address - Phone:469-360-2666
Mailing Address - Fax:
Practice Address - Street 1:101 S JENNINGS AVE STE 214
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104-1112
Practice Address - Country:US
Practice Address - Phone:469-360-2666
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-03
Last Update Date:2011-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX61275101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional