Provider Demographics
NPI:1780922559
Name:MARK A SCHEFFERS LMSW PLLC
Entity type:Organization
Organization Name:MARK A SCHEFFERS LMSW PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICIAN
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHEFFERS
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW
Authorized Official - Phone:269-350-6324
Mailing Address - Street 1:605 HOWARD ST
Mailing Address - Street 2:
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49008-1919
Mailing Address - Country:US
Mailing Address - Phone:269-350-6324
Mailing Address - Fax:
Practice Address - Street 1:605 HOWARD ST
Practice Address - Street 2:
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49008-1919
Practice Address - Country:US
Practice Address - Phone:269-350-6324
Practice Address - Fax:269-743-3694
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-29
Last Update Date:2013-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010913791041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2=========Medicaid