Provider Demographics
NPI:1548599129
Name:WURTSMITH, CASPER T (MA, LPC, CAADC)
Entity Type:Individual
Prefix:MR
First Name:CASPER
Middle Name:T
Last Name:WURTSMITH
Suffix:
Gender:M
Credentials:MA, LPC, CAADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1325 CRESTVIEW DR
Mailing Address - Street 2:UNIT 37
Mailing Address - City:PETOSKEY
Mailing Address - State:MI
Mailing Address - Zip Code:49770-9286
Mailing Address - Country:US
Mailing Address - Phone:231-838-8976
Mailing Address - Fax:
Practice Address - Street 1:318 E MITCHELL ST
Practice Address - Street 2:SUITE #2
Practice Address - City:PETOSKEY
Practice Address - State:MI
Practice Address - Zip Code:49770-2616
Practice Address - Country:US
Practice Address - Phone:231-838-8976
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-10
Last Update Date:2013-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401011588101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional