Basic Information
| Provider Information | |||||||||
| NPI: | 1669567285 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CASPER | ||||||||
| FirstName: | WILLIAM | ||||||||
| MiddleName: | BIRD | ||||||||
| NamePrefix: | MR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 11301 WILSHIRE BLVD. | ||||||||
| Address2: | BLDG. 256. ROOM 214 | ||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 90073 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3104783711 | ||||||||
| FaxNumber: | 3102683821 | ||||||||
| Practice Location | |||||||||
| Address1: | 11301 WILSHIRE BLVD. | ||||||||
| Address2: | BLDG. 256 ROOM 214 | ||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 90073 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3104783711 | ||||||||
| FaxNumber: | 3102683821 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/03/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | NONE REQUIRED | N | Behavioral Health & Social Service Providers | Counselor | Mental Health | 101YM0800X | NONE REQUIRED | CA | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.