Provider Demographics
NPI:1548457484
Name:MCCASKILL, EDDIE (LPC LCSW NCC)
Entity type:Individual
Prefix:MR
First Name:EDDIE
Middle Name:
Last Name:MCCASKILL
Suffix:
Gender:M
Credentials:LPC LCSW NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12613 MARINE AVE
Mailing Address - Street 2:
Mailing Address - City:CREVE COEUR
Mailing Address - State:MO
Mailing Address - Zip Code:63146-2413
Mailing Address - Country:US
Mailing Address - Phone:314-484-9984
Mailing Address - Fax:314-514-1851
Practice Address - Street 1:12613 MARINE
Practice Address - Street 2:
Practice Address - City:CREVE COEUR
Practice Address - State:MO
Practice Address - Zip Code:63146-2413
Practice Address - Country:US
Practice Address - Phone:314-484-9984
Practice Address - Fax:314-514-1851
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-25
Last Update Date:2007-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO001087101Y00000X
MO000723101YP2500X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional