Healthcare Provider Details

I. General information

NPI: 1548599129
Provider Name (Legal Business Name): CASPER T WURTSMITH MA, LPC, CAADC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/10/2009
Last Update Date: 11/01/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

318 E MITCHELL ST SUITE #2
PETOSKEY MI
49770-2616
US

IV. Provider business mailing address

1325 CRESTVIEW DR UNIT 37
PETOSKEY MI
49770-9286
US

V. Phone/Fax

Practice location:
  • Phone: 231-838-8976
  • Fax:
Mailing address:
  • Phone: 231-838-8976
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number6401011588
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: