Provider Demographics
NPI:1891047080
Name:RADLE, CASEY (MED, LPC)
Entity Type:Individual
Prefix:
First Name:CASEY
Middle Name:
Last Name:RADLE
Suffix:
Gender:F
Credentials:MED, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1501 CROCKER ST.
Mailing Address - Street 2:SUITE 1
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77019-4322
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1501 CROCKER ST.
Practice Address - Street 2:SUITE 1
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77019-4322
Practice Address - Country:US
Practice Address - Phone:832-209-2222
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-10-11
Last Update Date:2012-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX66574101Y00000X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional