Provider Demographics
NPI:1417703075
Name:PETR, KASSANDRA (LMFT-A)
Entity type:Individual
Prefix:
First Name:KASSANDRA
Middle Name:
Last Name:PETR
Suffix:
Gender:F
Credentials:LMFT-A
Other - Prefix:
Other - First Name:KASSANDRA
Other - Middle Name:
Other - Last Name:SULLIVAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1717 TOOMEY RD APT 105
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78704-0050
Mailing Address - Country:US
Mailing Address - Phone:940-395-9279
Mailing Address - Fax:
Practice Address - Street 1:1717 TOOMEY RD APT 105
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78704-0050
Practice Address - Country:US
Practice Address - Phone:940-395-9279
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-25
Last Update Date:2025-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX205489106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist