Provider Demographics
NPI:1447872734
Name:STOCKETT, CASEY JEANETTE
Entity type:Individual
Prefix:
First Name:CASEY
Middle Name:JEANETTE
Last Name:STOCKETT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8024 HARRIS DR
Mailing Address - Street 2:
Mailing Address - City:GARRETTSVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:44231-1014
Mailing Address - Country:US
Mailing Address - Phone:234-788-9006
Mailing Address - Fax:
Practice Address - Street 1:4041 N HIGH ST
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43214-3247
Practice Address - Country:US
Practice Address - Phone:614-262-0545
Practice Address - Fax:614-437-1554
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-11
Last Update Date:2020-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling