1124619911 NPI number — SIERRA M KASSON NCC, LMFT, CCTP-I

Table of content: SIERRA M KASSON NCC, LMFT, CCTP-I (NPI 1124619911)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1124619911 NPI number — SIERRA M KASSON NCC, LMFT, CCTP-I

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KASSON
Provider First Name:
SIERRA
Provider Middle Name:
M
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
NCC, LMFT, CCTP-I
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MESSENGER
Provider Other First Name:
SIERRA
Provider Other Middle Name:
MARIE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1124619911
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/25/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
131 HIGHWAY 22 S
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SHILOH
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
38376-5322
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
731-632-1317
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
131 HIGHWAY 22 S
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SHILOH
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
38376-5322
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
731-412-2240
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/03/2021

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: 106H00000X , with the licence number:  1888 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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