Healthcare Provider Details

I. General information

NPI: 1538602784
Provider Name (Legal Business Name): MCCASKILL FAMILY SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/21/2016
Last Update Date: 11/21/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

409 PLYMOUTH RD SUITE 250
PLYMOUTH MI
48170-1497
US

IV. Provider business mailing address

2040 GRAND RIVER ANX STE. 300
BRIGHTON MI
48114-5313
US

V. Phone/Fax

Practice location:
  • Phone: 734-416-9098
  • Fax: 734-416-0158
Mailing address:
  • Phone: 734-416-9098
  • Fax: 734-416-0158

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number6301012563
License Number StateMI

VIII. Authorized Official

Name: PAMELA A MCCASKILL
Title or Position: CLINICAL DIRECTOR
Credential: PH.D.
Phone: 734-416-9098