MEDICARE: BRENDA LEE CASEY, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	2002029846	MO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1033424585
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BRENDA LEE CASEY, LLC

Provider Business Mailing Address
First Line	:	106 FOUR SEASONS SHOPPING CTR
Second Line	:	SUITE 103B
City	:	CHESTERFIELD
State	:	MO
Zip	:	63017-3173
Country	:	US
Telephone Number	:	636-484-2733
Fax Number	:	314-392-9558

Provider Business Practice Location Address
First Line	:	106 FOUR SEASONS SHOPPING CTR
Second Line	:	SUITE 103B
City	:	CHESTERFIELD
State	:	MO
Zip	:	63017-3173
Country	:	US
Telephone Number	:	636-484-2733
Fax Number	:	314-392-9558

Authorized Official
Title or Position	:	COUNSELOR
Name	:	MS. BRENDA LEE CASEY
Credential	:	LCSW
Telephone Number	:	636-484-2733

Provider Enumeration Date	:	08/09/2010
Last Update Date	:	08/09/2010

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