Provider Demographics
NPI:1851899223
Name:SCHUMACHER, KIMBERLY ANN (PHD, LP)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:ANN
Last Name:SCHUMACHER
Suffix:
Gender:F
Credentials:PHD, LP
Other - Prefix:
Other - First Name:KIMBERLY
Other - Middle Name:ANN
Other - Last Name:MAURELLI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD, LP
Mailing Address - Street 1:720 W WACKERLY ST STE 11
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:MI
Mailing Address - Zip Code:48640-2769
Mailing Address - Country:US
Mailing Address - Phone:989-832-2165
Mailing Address - Fax:
Practice Address - Street 1:4912 E PICKARD ST
Practice Address - Street 2:
Practice Address - City:MT PLEASANT
Practice Address - State:MI
Practice Address - Zip Code:48858-2080
Practice Address - Country:US
Practice Address - Phone:989-832-2165
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-31
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301017330103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical