Provider Demographics
NPI:1912397753
Name:CASEY, MARISSA L (PSYD, LP)
Entity Type:Individual
Prefix:DR
First Name:MARISSA
Middle Name:L
Last Name:CASEY
Suffix:
Gender:F
Credentials:PSYD, LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2131 W REPUBLIC RD # 20
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65807-5705
Mailing Address - Country:US
Mailing Address - Phone:417-394-5900
Mailing Address - Fax:
Practice Address - Street 1:2131 W REPUBLIC RD # 20
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65807-5705
Practice Address - Country:US
Practice Address - Phone:417-394-5900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-02-02
Last Update Date:2022-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2015001330103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO490024018Medicaid