Provider Demographics
NPI:1750800322
Name:TAVARES, CASSIE (LPCC, NCC)
Entity type:Individual
Prefix:
First Name:CASSIE
Middle Name:
Last Name:TAVARES
Suffix:
Gender:F
Credentials:LPCC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:233 N TOWNSEND ST
Mailing Address - Street 2:
Mailing Address - City:MORGANFIELD
Mailing Address - State:KY
Mailing Address - Zip Code:42437-1436
Mailing Address - Country:US
Mailing Address - Phone:270-389-3240
Mailing Address - Fax:
Practice Address - Street 1:233 N TOWNSEND ST
Practice Address - Street 2:
Practice Address - City:MORGANFIELD
Practice Address - State:KY
Practice Address - Zip Code:42437
Practice Address - Country:US
Practice Address - Phone:270-389-3240
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-15
Last Update Date:2018-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY162895101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional