Healthcare Provider Details

I. General information

NPI: 1093161366
Provider Name (Legal Business Name): CASSIDEE BEAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/05/2016
Last Update Date: 12/28/2022
Certification Date: 12/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2815 OLD IDA RD
WHITEWRIGHT TX
75491-3560
US

IV. Provider business mailing address

3402 MEADOWVIEW DR
CORINTH TX
76210-2658
US

V. Phone/Fax

Practice location:
  • Phone: 903-421-6981
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: