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Organization
CASSY KELLY, LLC
Active
Organization
CASSY KELLY, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
STACEY M DEISTER (CREDENTIALER)
(816) 365-4070
Entity
Organization
Contact information
Practice address
7221 W 79TH ST STE 105, OVERLAND PARK, KS 66204-2906
(913) 444-0083
Mailing address
7221 W 79TH ST STE 105, OVERLAND PARK, KS 66204-2906
(913) 444-0083
Taxonomy
Speciality
Code
Description
License number
State
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
30004819650001
—
KS
Enumeration date
07/21/2022
Last updated
08/09/2022
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