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General NPI Number Information
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NPI Number | 1356660583
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Entity Type | Organization
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Legal Business Name | JOHN W. MCCASKILL, PH.D., PLLC
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Dates
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Enumeration Date | 05/27/2010
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Last Update Date | 05/29/2010
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Provider Practice Location Address
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Address Line | 409 PLYMOUTH RD STE 250
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City | PLYMOUTH
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State | MI
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Zip | 48170-1842
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Country | US
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Telephone | 734-416-9098
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Fax | 734-416-0158
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Provider Business Mailing Address
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Address Line | 409 PLYMOUTH RD STE 250
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City | PLYMOUTH
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State | MI
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Zip | 48170-1842
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Country | US
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Telephone | 734-416-9098
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Fax | 734-416-0158
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Authorized Official
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Title or Position | LICENSED CLINICAL PSYCHOLOGIST
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Name | DR. JOHN WALTON MCCASKILL IV
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Credential | PH.D.
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Telephone | 734-416-9098
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 6301012562
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License Number State | MI
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