1033455530 NPI number — MS. MICKIE LYNN CASSIDY LSA, CSFA

Table of content: JESENIA LOPEZ (NPI 1649927278)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1033455530 NPI number — MS. MICKIE LYNN CASSIDY LSA, CSFA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CASSIDY
Provider First Name:
MICKIE
Provider Middle Name:
LYNN
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
LSA, CSFA
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1033455530
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/02/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
701 JASE DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
COPPERAS COVE
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
76522-4432
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
512-743-8787
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1822 W BRAKER LN # 81603
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
AUSTIN
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78758-3606
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
512-973-9222
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/02/2013

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363AS0400X , with the licence number:  SA00649 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208600000X , with the licence number: SA00649 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)