Provider Demographics
NPI:1669567285
Name:CASPER, WILLIAM BIRD (MA)
Entity type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:BIRD
Last Name:CASPER
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11301 WILSHIRE BLVD.
Mailing Address - Street 2:BLDG. 256. ROOM 214
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90073
Mailing Address - Country:US
Mailing Address - Phone:310-478-3711
Mailing Address - Fax:310-268-3821
Practice Address - Street 1:11301 WILSHIRE BLVD.
Practice Address - Street 2:BLDG. 256 ROOM 214
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90073
Practice Address - Country:US
Practice Address - Phone:310-478-3711
Practice Address - Fax:310-268-3821
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NONE REQUIRED101YM0800X
CANONE REQUIRED101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health