Provider Demographics
NPI:1922134360
Name:SCHUSTER, MARK LEWIS (MA, MFT)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:LEWIS
Last Name:SCHUSTER
Suffix:
Gender:M
Credentials:MA, MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 4798
Mailing Address - Street 2:
Mailing Address - City:KAILUA KONA
Mailing Address - State:HI
Mailing Address - Zip Code:96745-4798
Mailing Address - Country:US
Mailing Address - Phone:808-987-0841
Mailing Address - Fax:
Practice Address - Street 1:3645 RUFFIN RD
Practice Address - Street 2:STE. 205
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92123-1845
Practice Address - Country:US
Practice Address - Phone:808-987-0841
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 8829106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist