MEDICARE: CASEY M. CARTER

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

General Provider Information

NPI Number	:	1124638895
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CASEY M. CARTER

Provider Business Mailing Address
First Line	:	PO BOX 34703
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98124-1703
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	7424 BRIDGEPORT WAY W STE 305
Second Line	:
City	:	LAKEWOOD
State	:	WA
Zip	:	98499-8135
Country	:	US
Telephone Number	:	253-246-6820
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/06/2020
Last Update Date	:	08/01/2023

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