Provider Demographics
NPI:1669526059
Name:SCHOETTLER, THERESA GAYLE (LCSW)
Entity type:Individual
Prefix:MRS
First Name:THERESA
Middle Name:GAYLE
Last Name:SCHOETTLER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:THERESA
Other - Middle Name:GAYLE
Other - Last Name:POULIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:300 E 15TH ST
Mailing Address - Street 2:
Mailing Address - City:MERCED
Mailing Address - State:CA
Mailing Address - Zip Code:95340-6217
Mailing Address - Country:US
Mailing Address - Phone:209-381-6879
Mailing Address - Fax:
Practice Address - Street 1:300 E 15TH ST
Practice Address - Street 2:
Practice Address - City:MERCED
Practice Address - State:CA
Practice Address - Zip Code:95340-6217
Practice Address - Country:US
Practice Address - Phone:209-381-6879
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS 190961041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical