Provider Demographics
NPI:1871866277
Name:SCHEFFERS, MARK ALLEN (LMSW, PLLC)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:ALLEN
Last Name:SCHEFFERS
Suffix:
Gender:M
Credentials:LMSW, PLLC
Other - Prefix:
Other - First Name:MARK
Other - Middle Name:A
Other - Last Name:SCHEFFERS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMSW
Mailing Address - Street 1:605 HOWARD ST
Mailing Address - Street 2:
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49008-1919
Mailing Address - Country:US
Mailing Address - Phone:269-350-6324
Mailing Address - Fax:
Practice Address - Street 1:605 HOWARD ST
Practice Address - Street 2:
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49008-1919
Practice Address - Country:US
Practice Address - Phone:269-350-6324
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-15
Last Update Date:2012-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010913791041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2454511722Medicaid