Healthcare Provider Details

I. General information

NPI: 1144944661
Provider Name (Legal Business Name): TALI KASSER NCSP, LCP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/28/2022
Last Update Date: 08/10/2026
Certification Date: 08/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 N WOOD RD STE 22
MURPHYSBORO IL
62966-6290
US

IV. Provider business mailing address

1400 N WOOD RD STE 22
MURPHYSBORO IL
62966-6290
US

V. Phone/Fax

Practice location:
  • Phone: 618-924-1623
  • Fax:
Mailing address:
  • Phone: 618-924-1623
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number071011404
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number230090640
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number1288579
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: