Healthcare Provider Details

I. General information

NPI: 1326656372
Provider Name (Legal Business Name): MARK A CASWELL MS, LLPC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/15/2020
Last Update Date: 07/15/2020
Certification Date: 07/15/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1505 WATERFORD PKWY
SAINT JOHNS MI
48879-9630
US

IV. Provider business mailing address

1913 HARDEN DR
OWOSSO MI
48867-3922
US

V. Phone/Fax

Practice location:
  • Phone: 989-292-3572
  • Fax:
Mailing address:
  • Phone: 989-277-8322
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number6401012490
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: