Provider Demographics
NPI:1811947385
Name:SCHMITT, EDWARD PHILLIP JR (PSYD)
Entity type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:PHILLIP
Last Name:SCHMITT
Suffix:JR
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1551 CAPRICE DR
Mailing Address - Street 2:
Mailing Address - City:JENISON
Mailing Address - State:MI
Mailing Address - Zip Code:49428-9582
Mailing Address - Country:US
Mailing Address - Phone:616-901-3696
Mailing Address - Fax:
Practice Address - Street 1:1362 BALDWIN ST
Practice Address - Street 2:
Practice Address - City:JENISON
Practice Address - State:MI
Practice Address - Zip Code:49428-8937
Practice Address - Country:US
Practice Address - Phone:616-901-3696
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-12
Last Update Date:2024-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301006888103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI680G011630OtherBLUE CROSS BLUE SHIELD
MI680G011630OtherBLUE CROSS BLUE SHIELD