MEDICARE: CASSIE BAY LPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	83804	TX
2	101YP2500X	Professional Counselor	83804	TX

General Provider Information

NPI Number	:	1174350763
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CASSIE BAY LPC

Provider Business Mailing Address
First Line	:	3303 LEE PKWY STE 102
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75219-5100
Country	:	US
Telephone Number	:	214-357-4001
Fax Number	:

Provider Business Practice Location Address
First Line	:	1208 W MAGNOLIA AVE
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76104-4472
Country	:	US
Telephone Number	:	214-357-4001
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/17/2024
Last Update Date	:	02/11/2026

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Directions to “ CASSIE BAY LPC” Practice Location

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