Provider Demographics
NPI:1669642682
Name:SCHUTEN, AMY A (LISAC)
Entity Type:Individual
Prefix:MS
First Name:AMY
Middle Name:A
Last Name:SCHUTEN
Suffix:
Gender:F
Credentials:LISAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1930 S ALMA SCHOOL RD
Mailing Address - Street 2:SUITE A208
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85210-3064
Mailing Address - Country:US
Mailing Address - Phone:480-838-5550
Mailing Address - Fax:480-756-8201
Practice Address - Street 1:1930 S ALMA SCHOOL RD
Practice Address - Street 2:SUITE A208
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85210-3064
Practice Address - Country:US
Practice Address - Phone:480-838-5550
Practice Address - Fax:480-756-8201
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-05
Last Update Date:2008-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLISAC-10975101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)