Provider Demographics
NPI:1043859762
Name:PUCKETT, CASSIE (LCSW, LCADC, ICGC-I)
Entity type:Individual
Prefix:
First Name:CASSIE
Middle Name:
Last Name:PUCKETT
Suffix:
Gender:F
Credentials:LCSW, LCADC, ICGC-I
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1315 PENNSYLVANIA AVE
Mailing Address - Street 2:
Mailing Address - City:LEWISPORT
Mailing Address - State:KY
Mailing Address - Zip Code:42351-2444
Mailing Address - Country:US
Mailing Address - Phone:270-922-2049
Mailing Address - Fax:
Practice Address - Street 1:1100 WALNUT ST
Practice Address - Street 2:
Practice Address - City:OWENSBORO
Practice Address - State:KY
Practice Address - Zip Code:42301-2956
Practice Address - Country:US
Practice Address - Phone:270-689-6500
Practice Address - Fax:270-689-6677
Is Sole Proprietor?:No
Enumeration Date:2019-12-27
Last Update Date:2024-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY281314101YA0400X
KY254407104100000X
KY2577531041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No104100000XBehavioral Health & Social Service ProvidersSocial Worker