Individual
CASSI STARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LIMHP
Contact information
Practice address
1000 W 29TH ST STE 230, SOUTH SIOUX CITY, NE 68776-3852
(402) 913-0552
Mailing address
PO BOX 894, PONCA, NE 68770-0894
(308) 631-9456
(308) 532-0389
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
082666
IA
101YM0800X
Mental Health Counselor
1812
NE
101YM0800X
Mental Health Counselor
8324
NE
101YM0800X
Mental Health Counselor
Primary
854
NE
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
10025953600
—
NE
Enumeration date
06/18/2007
Last updated
10/01/2021
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