Provider Demographics
NPI:1144209909
Name:CASPER, THOMAS ROGER (LCPC)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:ROGER
Last Name:CASPER
Suffix:
Gender:M
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1110 CEDAR CT
Mailing Address - Street 2:
Mailing Address - City:CARBONDALE
Mailing Address - State:IL
Mailing Address - Zip Code:62901-5300
Mailing Address - Country:US
Mailing Address - Phone:618-457-4144
Mailing Address - Fax:618-457-6091
Practice Address - Street 1:1110 CEDAR CT
Practice Address - Street 2:
Practice Address - City:CARBONDALE
Practice Address - State:IL
Practice Address - Zip Code:62901-5300
Practice Address - Country:US
Practice Address - Phone:618-457-4144
Practice Address - Fax:618-457-6091
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional