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General NPI Number Information
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NPI Number | 1518476977
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Entity Type | Individual
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Provider Name | CASEY RYAN BS, MA
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Gender | Male
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Dates
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Enumeration Date | 09/28/2017
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Last Update Date | 12/09/2025
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Provider Practice Location Address
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Address Line | 279 SUMMIT DR
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City | WATERFORD
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State | MI
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Zip | 48328-3364
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Country | US
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Telephone | 800-615-0411
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Fax |
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Provider Business Mailing Address
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Address Line | 6964 PEBBLE PARK CIR
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City | WEST BLOOMFIELD
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State | MI
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Zip | 48322-3510
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Country | US
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Telephone | 303-242-2052
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number |
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License Number State | CO
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Taxonomy #3
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number |
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License Number State | MI
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