Provider Demographics
NPI:1558962563
Name:THIGPEN, CASSYCEL
Entity type:Individual
Prefix:
First Name:CASSYCEL
Middle Name:
Last Name:THIGPEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4894A HIGHWAY 584 LIBERTY
Mailing Address - Street 2:4894A HIGHWAY 584 LIBERTY
Mailing Address - City:LIBERTY
Mailing Address - State:MS
Mailing Address - Zip Code:39645
Mailing Address - Country:US
Mailing Address - Phone:601-618-1299
Mailing Address - Fax:
Practice Address - Street 1:4894A HIGHWAY 584 LIBERTY
Practice Address - Street 2:4894A HIGHWAY 584 LIBERTY
Practice Address - City:LIBERTY
Practice Address - State:MS
Practice Address - Zip Code:39645
Practice Address - Country:US
Practice Address - Phone:601-618-1299
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-05
Last Update Date:2020-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounselingGroup - Single Specialty