Provider Demographics
NPI:1861833014
Name:SCHOETTLE, LISA RENAE (MA LPC)
Entity Type:Individual
Prefix:MRS
First Name:LISA
Middle Name:RENAE
Last Name:SCHOETTLE
Suffix:
Gender:F
Credentials:MA LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 WILLIS ST
Mailing Address - Street 2:
Mailing Address - City:BAD AXE
Mailing Address - State:MI
Mailing Address - Zip Code:48413-1148
Mailing Address - Country:US
Mailing Address - Phone:989-975-0190
Mailing Address - Fax:989-269-5180
Practice Address - Street 1:117 S PORT CRESCENT ST
Practice Address - Street 2:
Practice Address - City:BAD AXE
Practice Address - State:MI
Practice Address - Zip Code:48413-1388
Practice Address - Country:US
Practice Address - Phone:989-269-5180
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-16
Last Update Date:2013-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401011934101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional