Provider Demographics
NPI:1013474899
Name:CARRASCO, CASSIE
Entity type:Individual
Prefix:
First Name:CASSIE
Middle Name:
Last Name:CARRASCO
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1616 WABASH AVE STE 7
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76107-6598
Mailing Address - Country:US
Mailing Address - Phone:682-233-4153
Mailing Address - Fax:
Practice Address - Street 1:1616 WABASH AVE STE 7
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76107-6598
Practice Address - Country:US
Practice Address - Phone:682-233-4153
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-27
Last Update Date:2025-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional