Provider Demographics
NPI:1609387786
Name:SCHLUTER, THOMAS W JR (LCDC III)
Entity Type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:W
Last Name:SCHLUTER
Suffix:JR
Gender:M
Credentials:LCDC III
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:780 PARK AVE W STE D
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:44906-3009
Mailing Address - Country:US
Mailing Address - Phone:567-303-8821
Mailing Address - Fax:419-709-8132
Practice Address - Street 1:780 PARK AVE W STE D
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:OH
Practice Address - Zip Code:44906-3009
Practice Address - Country:US
Practice Address - Phone:567-303-8821
Practice Address - Fax:419-709-8132
Is Sole Proprietor?:No
Enumeration Date:2017-10-17
Last Update Date:2017-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHLCDCIII121021101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)