Healthcare Provider Details

I. General information

NPI: 1114356219
Provider Name (Legal Business Name): JAMES CASEY PSYD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/08/2013
Last Update Date: 11/08/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

115 28TH AVE N
NASHVILLE TN
37203-1411
US

IV. Provider business mailing address

2150 PETWAY RD
ASHLAND CITY TN
37015-5140
US

V. Phone/Fax

Practice location:
  • Phone: 760-880-8585
  • Fax:
Mailing address:
  • Phone: 760-880-8585
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TA0400X
TaxonomyAddiction (Substance Use Disorder) Psychologist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number3041
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: