Healthcare Provider Details

I. General information

NPI: 1770155384
Provider Name (Legal Business Name): MICHAEL CHRISTOPHER SCHLUETER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2021
Last Update Date: 12/13/2023
Certification Date: 12/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

360 S WESTLAKE AVE
LOS ANGELES CA
90057-2906
US

IV. Provider business mailing address

360 S WESTLAKE AVE
LOS ANGELES CA
90057-2906
US

V. Phone/Fax

Practice location:
  • Phone: 213-483-9201
  • Fax: 213-382-0136
Mailing address:
  • Phone: 213-483-9201
  • Fax: 213-382-0136

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCI40911123
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: