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NPI Code Detail

MEDICARE: CASEY FORSYTH CASAC, SUDP

MEDICARE: CASEY FORSYTH CASAC, SUDP
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
1101YA0400XAddiction (Substance Use Disorder) CounselorCP61016510WA
2101YA0400XAddiction (Substance Use Disorder) Counselor2306NY

General Provider Information

NPI Number : 1700321791
Entity Type Code : Individual
Provider Name (Legal Business Name) : CASEY FORSYTH CASAC, SUDP
Provider Business Mailing Address
First Line : 808 SHERMAN ST NW
Second Line :
City : OLYMPIA
State : WA
Zip : 98502-4830
Country : US
Telephone Number : 607-345-0503
Fax Number :
Provider Business Practice Location Address
First Line : 235 S 3RD ST
Second Line :
City : SHELTON
State : WA
Zip : 98584-2255
Country : US
Telephone Number : 360-426-0890
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/29/2016
Last Update Date : 06/07/2023

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