Healthcare Provider Details

I. General information

NPI: 1356660583
Provider Name (Legal Business Name): JOHN W. MCCASKILL, PH.D., PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/27/2010
Last Update Date: 05/29/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

409 PLYMOUTH RD STE 250
PLYMOUTH MI
48170-1842
US

IV. Provider business mailing address

409 PLYMOUTH RD STE 250
PLYMOUTH MI
48170-1842
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 Code103TC0700X
TaxonomyClinical Psychologist
License Number6301012562
License Number StateMI

VIII. Authorized Official

Name: DR. JOHN WALTON MCCASKILL IV
Title or Position: LICENSED CLINICAL PSYCHOLOGIST
Credential: PH.D.
Phone: 734-416-9098