Provider Demographics
NPI:1013143114
Name:VETTER, CASSANDRA MARIE (MS)
Entity Type:Individual
Prefix:
First Name:CASSANDRA
Middle Name:MARIE
Last Name:VETTER
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14444 CALIFORNIA AVE STE A
Mailing Address - Street 2:
Mailing Address - City:VICTORVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:92392-9505
Mailing Address - Country:US
Mailing Address - Phone:760-660-4800
Mailing Address - Fax:760-552-4414
Practice Address - Street 1:14444 CALIFORNIA AVE STE A
Practice Address - Street 2:
Practice Address - City:VICTORVILLE
Practice Address - State:CA
Practice Address - Zip Code:92392-9505
Practice Address - Country:US
Practice Address - Phone:760-660-4800
Practice Address - Fax:760-552-4414
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-03
Last Update Date:2023-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALMFT84637106H00000X
CA63576106H00000X
CA84637106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist