Provider Demographics
NPI:1740801976
Name:SEVERS, KASEY LANE
Entity Type:Individual
Prefix:
First Name:KASEY
Middle Name:LANE
Last Name:SEVERS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:307F SAWDUST RD
Mailing Address - Street 2:
Mailing Address - City:SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:77380-2240
Mailing Address - Country:US
Mailing Address - Phone:346-351-2923
Mailing Address - Fax:346-229-1676
Practice Address - Street 1:307F SAWDUST RD
Practice Address - Street 2:
Practice Address - City:SPRING
Practice Address - State:TX
Practice Address - Zip Code:77380-2240
Practice Address - Country:US
Practice Address - Phone:346-351-2923
Practice Address - Fax:346-229-1676
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-28
Last Update Date:2020-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician