Provider Demographics
NPI:1215455506
Name:ANDREA CASSELL LMSW LLC
Entity type:Organization
Organization Name:ANDREA CASSELL LMSW LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANDREA
Authorized Official - Middle Name:
Authorized Official - Last Name:CASSELL
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW
Authorized Official - Phone:231-409-3900
Mailing Address - Street 1:2536 TWIN BAY DR
Mailing Address - Street 2:
Mailing Address - City:TRAVERSE CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49696-8522
Mailing Address - Country:US
Mailing Address - Phone:231-409-3900
Mailing Address - Fax:
Practice Address - Street 1:13561 S WEST BAY SHORE DR STE 309
Practice Address - Street 2:
Practice Address - City:TRAVERSE CITY
Practice Address - State:MI
Practice Address - Zip Code:49684-6299
Practice Address - Country:US
Practice Address - Phone:231-409-3900
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-09-06
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801093594261QM0850X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health