MEDICARE: ANDREA CASSELL LMSW 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	261QM0850X	Adult Mental Health Clinic/Center	6801093594	MI

General Provider Information

NPI Number	:	1215455506
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ANDREA CASSELL LMSW LLC

Provider Business Mailing Address
First Line	:	2536 TWIN BAY DR
Second Line	:
City	:	TRAVERSE CITY
State	:	MI
Zip	:	49696-8522
Country	:	US
Telephone Number	:	231-409-3900
Fax Number	:

Provider Business Practice Location Address
First Line	:	13561 S WEST BAY SHORE DR STE 309
Second Line	:
City	:	TRAVERSE CITY
State	:	MI
Zip	:	49684-6299
Country	:	US
Telephone Number	:	231-409-3900
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	ANDREA CASSELL
Credential	:	LMSW
Telephone Number	:	231-409-3900

Provider Enumeration Date	:	09/06/2017
Last Update Date	:	03/17/2018

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