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General NPI Number Information
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NPI Number | 1568856227
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Entity Type | Organization
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Legal Business Name | ANDREA CASEY, PH.D., L.P., PLLC
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Dates
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Enumeration Date | 03/20/2015
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Last Update Date | 03/30/2015
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Provider Practice Location Address
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Address Line | 119 S LEROY ST C/O HOPE COUNSELING CENTER
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City | FENTON
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State | MI
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Zip | 48430-2637
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Country | US
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Telephone | 810-516-0615
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Fax |
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Provider Business Mailing Address
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Address Line | 4370 ISLAND VIEW DR
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City | FENTON
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State | MI
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Zip | 48430-9145
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Country | US
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Telephone | 810-750-5093
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Fax |
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Authorized Official
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Title or Position | MEMBER
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Name | ANDREA CASEY
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Credential | PH.D.
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Telephone | 810-750-5093
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number | 6301008470
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License Number State | MI
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