Provider Demographics
NPI:1356985386
Name:SCHMUKER, MATTHEW M (LLPC, LLMFT)
Entity type:Individual
Prefix:MR
First Name:MATTHEW
Middle Name:M
Last Name:SCHMUKER
Suffix:
Gender:M
Credentials:LLPC, LLMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3109 72ND ST SW
Mailing Address - Street 2:
Mailing Address - City:BYRON CENTER
Mailing Address - State:MI
Mailing Address - Zip Code:49315-8009
Mailing Address - Country:US
Mailing Address - Phone:616-528-0352
Mailing Address - Fax:
Practice Address - Street 1:4565 WILSON AVE SW STE 3A
Practice Address - Street 2:
Practice Address - City:GRANDVILLE
Practice Address - State:MI
Practice Address - Zip Code:49418-2371
Practice Address - Country:US
Practice Address - Phone:616-805-4416
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-02
Last Update Date:2019-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4101006783106H00000X
MI6401016470101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist