Individual
DR. CASEY WAKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PSY.D.
Contact information
Practice address
5810 RALSTON ST FL 2, VENTURA, CA 93003-5908
(805) 642-7033
Mailing address
5810 RALSTON ST, VENTURA, CA 93003-5908
(805) 796-7637
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
—
—
101YP2500X
Professional Counselor
—
—
103TC0700X
Clinical Psychologist
Primary
PSY28390
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7068
—
CA
05
—
7420
—
CA
Enumeration date
07/28/2008
Last updated
12/20/2017
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