MEDICARE: ERIC DANIEL CASSIUS LPC, MHSP, CHT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	LPC0000000793	TN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	3157550	OTHER		BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1336208370
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ERIC DANIEL CASSIUS LPC, MHSP, CHT

Provider Business Mailing Address
First Line	:	815 MOUNT MORIAH RD
Second Line	:
City	:	MEMPHIS
State	:	TN
Zip	:	38117-5704
Country	:	US
Telephone Number	:	901-685-5491
Fax Number	:	901-685-8292

Provider Business Practice Location Address
First Line	:	815 MOUNT MORIAH RD
Second Line	:
City	:	MEMPHIS
State	:	TN
Zip	:	38117-5704
Country	:	US
Telephone Number	:	901-685-5491
Fax Number	:	901-685-8292

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/06/2006
Last Update Date	:	05/14/2010

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