Provider Demographics
NPI:1396228524
Name:SHAW SALYER, KASEY (LCSW)
Entity Type:Individual
Prefix:
First Name:KASEY
Middle Name:
Last Name:SHAW SALYER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:KASEY
Other - Middle Name:
Other - Last Name:SHAW
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3611 W PIONEER PKWY STE H
Mailing Address - Street 2:
Mailing Address - City:PANTEGO
Mailing Address - State:TX
Mailing Address - Zip Code:76013-4516
Mailing Address - Country:US
Mailing Address - Phone:682-587-7747
Mailing Address - Fax:
Practice Address - Street 1:6012 REEF POINT LN STE C
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76135-2056
Practice Address - Country:US
Practice Address - Phone:806-543-9287
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-13
Last Update Date:2020-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX623931041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical