Provider Demographics
NPI:1649367616
Name:CASSTEVENS, PATTYE JEAN (LPC)
Entity type:Individual
Prefix:MRS
First Name:PATTYE
Middle Name:JEAN
Last Name:CASSTEVENS
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1125 W ABRAM ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76013-6987
Mailing Address - Country:US
Mailing Address - Phone:817-633-7490
Mailing Address - Fax:817-633-7436
Practice Address - Street 1:1125 W ABRAM ST
Practice Address - Street 2:SUITE 101
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76013-6987
Practice Address - Country:US
Practice Address - Phone:817-633-7490
Practice Address - Fax:817-633-7436
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-09
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX05591101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX179244201Medicaid