Provider Demographics
NPI:1912443482
Name:WURSTER, JASPER H (LCPC, LPC)
Entity Type:Individual
Prefix:
First Name:JASPER
Middle Name:H
Last Name:WURSTER
Suffix:
Gender:F
Credentials:LCPC, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1518 E LINCOLN AVE
Mailing Address - Street 2:
Mailing Address - City:ROYAL OAK
Mailing Address - State:MI
Mailing Address - Zip Code:48067-3402
Mailing Address - Country:US
Mailing Address - Phone:485-719-2812
Mailing Address - Fax:
Practice Address - Street 1:1518 E LINCOLN AVE
Practice Address - Street 2:
Practice Address - City:ROYAL OAK
Practice Address - State:MI
Practice Address - Zip Code:48067-3402
Practice Address - Country:US
Practice Address - Phone:248-571-9281
Practice Address - Fax:313-789-1664
Is Sole Proprietor?:No
Enumeration Date:2017-01-09
Last Update Date:2023-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178.009888101YM0800X
IL180.011626101YM0800X
MI6401223373101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health