Provider Demographics
NPI:1780810879
Name:SCHUTTER, MARK EUGENE (PHD)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:EUGENE
Last Name:SCHUTTER
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 HILLCREST DR
Mailing Address - Street 2:LARNED STATE HOSPITAL
Mailing Address - City:LARNED
Mailing Address - State:KS
Mailing Address - Zip Code:67550-4000
Mailing Address - Country:US
Mailing Address - Phone:620-285-5806
Mailing Address - Fax:
Practice Address - Street 1:300 HILLCREST DR
Practice Address - Street 2:LARNED STATE HOSPITAL
Practice Address - City:LARNED
Practice Address - State:KS
Practice Address - Zip Code:67550-4000
Practice Address - Country:US
Practice Address - Phone:620-285-5806
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-03
Last Update Date:2009-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE431103TC0700X
KS1170103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS1170OtherPSYCHOLOGY LICENSE
NE431OtherPSYCHOLOGY LICENSE