Healthcare Provider Details

I. General information

NPI: 1861741043
Provider Name (Legal Business Name): DANIEL D SCHRECK PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/05/2012
Last Update Date: 04/02/2021
Certification Date: 04/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2112 INWOOD DR
FORT WAYNE IN
46815-7115
US

IV. Provider business mailing address

2112 INWOOD DR
FORT WAYNE IN
46815-7115
US

V. Phone/Fax

Practice location:
  • Phone: 260-218-8299
  • Fax:
Mailing address:
  • Phone: 260-218-8299
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number87000235A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code101YP1600X
TaxonomyPastoral Counselor
License Number2081776
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: