Provider Demographics
NPI:1144944661
Name:KASSER, TALI (NCSP, LCP)
Entity type:Individual
Prefix:DR
First Name:TALI
Middle Name:
Last Name:KASSER
Suffix:
Gender:F
Credentials:NCSP, LCP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1400 N WOOD RD STE 22
Mailing Address - Street 2:
Mailing Address - City:MURPHYSBORO
Mailing Address - State:IL
Mailing Address - Zip Code:62966-6290
Mailing Address - Country:US
Mailing Address - Phone:618-924-1623
Mailing Address - Fax:
Practice Address - Street 1:1400 N WOOD RD STE 22
Practice Address - Street 2:
Practice Address - City:MURPHYSBORO
Practice Address - State:IL
Practice Address - Zip Code:62966-6290
Practice Address - Country:US
Practice Address - Phone:618-924-1623
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-28
Last Update Date:2025-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA230090640103TS0200X
IL1288579103TS0200X
IL071011404103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool