Healthcare Provider Details

I. General information

NPI: 1104423888
Provider Name (Legal Business Name): SW ANN ARBOR PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/05/2020
Last Update Date: 10/05/2020
Certification Date: 10/05/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

625 E LIBERTY ST STE 205
ANN ARBOR MI
48104-2013
US

IV. Provider business mailing address

625 E LIBERTY ST STE 205
ANN ARBOR MI
48104-2013
US

V. Phone/Fax

Practice location:
  • Phone: 248-981-5975
  • Fax:
Mailing address:
  • Phone: 248-981-5975
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code103TP2701X
TaxonomyGroup Psychotherapy Psychologist
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. ANDREW T SCHMALE
Title or Position: OWNER
Credential: MD
Phone: 248-981-5975