Provider Demographics
NPI:1780121079
Name:CASEY, ASHLIE (LCSW)
Entity type:Individual
Prefix:MRS
First Name:ASHLIE
Middle Name:
Last Name:CASEY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9213 N 103RD EAST PL
Mailing Address - Street 2:
Mailing Address - City:OWASSO
Mailing Address - State:OK
Mailing Address - Zip Code:74055-6983
Mailing Address - Country:US
Mailing Address - Phone:918-629-9091
Mailing Address - Fax:
Practice Address - Street 1:9213 N 103RD EAST PL
Practice Address - Street 2:
Practice Address - City:OWASSO
Practice Address - State:OK
Practice Address - Zip Code:74055-6983
Practice Address - Country:US
Practice Address - Phone:918-629-9091
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-24
Last Update Date:2017-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2748101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health