Provider Demographics
NPI:1336271865
Name:KASPER, THEODORE KARL (LMSW)
Entity Type:Individual
Prefix:MR
First Name:THEODORE
Middle Name:KARL
Last Name:KASPER
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12211 MENTZ DR
Mailing Address - Street 2:
Mailing Address - City:BRUCE
Mailing Address - State:MI
Mailing Address - Zip Code:48065-4436
Mailing Address - Country:US
Mailing Address - Phone:586-255-2259
Mailing Address - Fax:
Practice Address - Street 1:12211 MENTZ DR
Practice Address - Street 2:
Practice Address - City:BRUCE
Practice Address - State:MI
Practice Address - Zip Code:48065-4436
Practice Address - Country:US
Practice Address - Phone:586-255-2259
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801059521101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health