Basic Information
| Provider Information | |||||||||
| NPI: | 1548935034 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CASSELS | ||||||||
| FirstName: | CONNIE | ||||||||
| MiddleName: | LOONEY | ||||||||
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| Credential: | NCSP, LSSP | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1300 | ||||||||
| Address2: | |||||||||
| City: | WINNSBORO | ||||||||
| State: | LA | ||||||||
| PostalCode: | 712951300 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3184356377 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 2104 LOOP RD STE C | ||||||||
| Address2: | |||||||||
| City: | WINNSBORO | ||||||||
| State: | LA | ||||||||
| PostalCode: | 712953341 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3184356377 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/16/2021 | ||||||||
| LastUpdateDate: | 08/16/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/16/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103TB0200X | LSSP010 | LA | Y | Behavioral Health & Social Service Providers | Psychologist | Cognitive & Behavioral |
No ID Information.