=====================================================
General NPI Number Information
=====================================================
NPI Number | 1538602784
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MCCASKILL FAMILY SERVICES
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/21/2016
-----------------------------------------------------
Last Update Date | 11/21/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 409 PLYMOUTH RD SUITE 250
-----------------------------------------------------
City | PLYMOUTH
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48170-1497
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 734-416-9098
-----------------------------------------------------
Fax | 734-416-0158
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2040 GRAND RIVER ANX STE. 300
-----------------------------------------------------
City | BRIGHTON
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48114-5313
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 734-416-9098
-----------------------------------------------------
Fax | 734-416-0158
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CLINICAL DIRECTOR
-----------------------------------------------------
Name | PAMELA A MCCASKILL
-----------------------------------------------------
Credential | PH.D.
-----------------------------------------------------
Telephone | 734-416-9098
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number | 6301012563
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------