Provider Demographics
NPI:1700268661
Name:SCHRADER, MICHAEL LUKE (BA)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:LUKE
Last Name:SCHRADER
Suffix:
Gender:M
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 SHERIDAN RD STE 106
Mailing Address - Street 2:
Mailing Address - City:BREMERTON
Mailing Address - State:WA
Mailing Address - Zip Code:98310-2701
Mailing Address - Country:US
Mailing Address - Phone:360-373-5031
Mailing Address - Fax:
Practice Address - Street 1:900 SHERIDAN RD STE 106
Practice Address - Street 2:
Practice Address - City:BREMERTON
Practice Address - State:WA
Practice Address - Zip Code:98310-2701
Practice Address - Country:US
Practice Address - Phone:360-415-5866
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-26
Last Update Date:2015-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACG60512210101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor