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General NPI Number Information
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NPI Number | 1548599129
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Entity Type | Individual
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Provider Name | CASPER T WURTSMITH MA, LPC, CAADC
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Gender | Male
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Dates
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Enumeration Date | 12/10/2009
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Last Update Date | 11/01/2013
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Provider Practice Location Address
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Address Line | 318 E MITCHELL ST SUITE #2
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City | PETOSKEY
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State | MI
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Zip | 49770-2616
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Country | US
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Telephone | 231-838-8976
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Fax |
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Provider Business Mailing Address
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Address Line | 1325 CRESTVIEW DR UNIT 37
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City | PETOSKEY
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State | MI
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Zip | 49770-9286
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Country | US
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Telephone | 231-838-8976
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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 | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 6401011588
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License Number State | MI
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