Provider Demographics
NPI:1578109807
Name:CASON, ROSHETTA LEE (MA, LPC)
Entity Type:Individual
Prefix:
First Name:ROSHETTA
Middle Name:LEE
Last Name:CASON
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3705 FLAT ROCK MOUNTAIN DR
Mailing Address - Street 2:
Mailing Address - City:KILLEEN
Mailing Address - State:TX
Mailing Address - Zip Code:76549-6530
Mailing Address - Country:US
Mailing Address - Phone:843-200-8776
Mailing Address - Fax:
Practice Address - Street 1:3705 FLAT ROCK MOUNTAIN DR
Practice Address - Street 2:
Practice Address - City:KILLEEN
Practice Address - State:TX
Practice Address - Zip Code:76549-6530
Practice Address - Country:US
Practice Address - Phone:843-200-8776
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-21
Last Update Date:2019-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX78300101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional