Provider Demographics
NPI:1861958597
Name:RUCKER, CASSIDY K (LPC)
Entity type:Individual
Prefix:
First Name:CASSIDY
Middle Name:K
Last Name:RUCKER
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 1:13767 PELLA LN
Mailing Address - Street 2:
Mailing Address - City:NEOSHO
Mailing Address - State:MO
Mailing Address - Zip Code:64850-8781
Mailing Address - Country:US
Mailing Address - Phone:479-368-2911
Mailing Address - Fax:479-391-5254
Practice Address - Street 1:3901 W FINANCIAL PKWY STE 101
Practice Address - Street 2:
Practice Address - City:ROGERS
Practice Address - State:AR
Practice Address - Zip Code:72758-1471
Practice Address - Country:US
Practice Address - Phone:479-986-8655
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-19
Last Update Date:2025-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARP2107011101YP2500X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional