Provider Demographics
NPI:1609147131
Name:MCCASLIN, INGRID RAINA
Entity Type:Individual
Prefix:MRS
First Name:INGRID
Middle Name:RAINA
Last Name:MCCASLIN
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:INGRID
Other - Middle Name:RAINA
Other - Last Name:LARSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1270 EIDER CIR
Mailing Address - Street 2:
Mailing Address - City:FALLON
Mailing Address - State:NV
Mailing Address - Zip Code:89406-6132
Mailing Address - Country:US
Mailing Address - Phone:425-350-4608
Mailing Address - Fax:
Practice Address - Street 1:1101 W MOANA LN STE 2
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89509-4734
Practice Address - Country:US
Practice Address - Phone:775-337-2394
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-01-13
Last Update Date:2012-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst