Provider Demographics
NPI:1932690229
Name:FABRE, CASEY MASON (MA)
Entity Type:Individual
Prefix:
First Name:CASEY
Middle Name:MASON
Last Name:FABRE
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:CASEY
Other - Middle Name:MICHELLE
Other - Last Name:MASON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:102 W 2ND ST
Mailing Address - Street 2:
Mailing Address - City:THIBODAUX
Mailing Address - State:LA
Mailing Address - Zip Code:70301-3004
Mailing Address - Country:US
Mailing Address - Phone:985-446-5244
Mailing Address - Fax:
Practice Address - Street 1:102 W 2ND ST
Practice Address - Street 2:
Practice Address - City:THIBODAUX
Practice Address - State:LA
Practice Address - Zip Code:70301
Practice Address - Country:US
Practice Address - Phone:985-446-5244
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-23
Last Update Date:2021-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X, 171M00000X
LA7636101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No171M00000XOther Service ProvidersCase Manager/Care Coordinator