Provider Demographics
NPI:1639508856
Name:HASKELL, CASEY
Entity Type:Individual
Prefix:
First Name:CASEY
Middle Name:
Last Name:HASKELL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 898
Mailing Address - Street 2:
Mailing Address - City:GUNNISON
Mailing Address - State:CO
Mailing Address - Zip Code:81230-0898
Mailing Address - Country:US
Mailing Address - Phone:970-943-2484
Mailing Address - Fax:
Practice Address - Street 1:104 TOMICHI HL
Practice Address - Street 2:EXCALANTE CENTER
Practice Address - City:GUNNISON
Practice Address - State:CO
Practice Address - Zip Code:81231-0898
Practice Address - Country:US
Practice Address - Phone:970-943-2484
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-11-07
Last Update Date:2013-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health