MEDICARE: BRENT E CASE

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	101YP2500X	Professional Counselor	LPC-12277	AZ

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	:	1952330656
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRENT E CASE

Provider Business Mailing Address
First Line	:	463 S. LAKE POWELL BLVD
Second Line	:	PO BOX 790
City	:	PAGE
State	:	AZ
Zip	:	86040-0790
Country	:	US
Telephone Number	:	928-645-5113
Fax Number	:	928-645-3254

Provider Business Practice Location Address
First Line	:	463 S. LAKE POWELL BLVD
Second Line	:
City	:	PAGE
State	:	AZ
Zip	:	86040-0790
Country	:	US
Telephone Number	:	928-645-5113
Fax Number	:	928-645-3254

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

Provider Enumeration Date	:	07/03/2006
Last Update Date	:	07/09/2007

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Directions to “ BRENT E CASE ” Practice Location

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