Healthcare Provider Details

I. General information

NPI: 1235841065
Provider Name (Legal Business Name): CASEY THEISEN MSW, CPHT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/26/2022
Last Update Date: 07/29/2025
Certification Date: 07/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

622 E GRAND RIVER AVE
HOWELL MI
48843-2329
US

IV. Provider business mailing address

622 E GRAND RIVER AVE
HOWELL MI
48843-2329
US

V. Phone/Fax

Practice location:
  • Phone: 517-548-0081
  • Fax: 517-548-0498
Mailing address:
  • Phone: 517-548-0081
  • Fax: 517-548-0498

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License Number5303024432
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code374J00000X
TaxonomyDoula
License Number
License Number StateMI
# 3
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6851119159
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: