Provider Demographics
NPI:1619134467
Name:KASITATI, JANIS LEA (MS, LPC)
Entity Type:Individual
Prefix:MRS
First Name:JANIS
Middle Name:LEA
Last Name:KASITATI
Suffix:
Gender:F
Credentials:MS, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1164
Mailing Address - Street 2:130 MYRTLE DR.
Mailing Address - City:NEW BOSTON
Mailing Address - State:TX
Mailing Address - Zip Code:75570-1164
Mailing Address - Country:US
Mailing Address - Phone:903-628-2674
Mailing Address - Fax:
Practice Address - Street 1:130 MYRTLE DR
Practice Address - Street 2:
Practice Address - City:NEW BOSTON
Practice Address - State:TX
Practice Address - Zip Code:75570-3608
Practice Address - Country:US
Practice Address - Phone:903-628-2674
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-20
Last Update Date:2008-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX20254101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional