Healthcare Provider Details

I. General information

NPI: 1457046963
Provider Name (Legal Business Name): DANIEL EUGENE SCHMIDT LLPC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/10/2023
Last Update Date: 02/23/2024
Certification Date: 02/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

534 FOUNTAIN ST NE
GRAND RAPIDS MI
49503-3422
US

IV. Provider business mailing address

2262 TIMBERWOOD DR SE
GRAND RAPIDS MI
49508-5047
US

V. Phone/Fax

Practice location:
  • Phone: 616-456-1178
  • Fax:
Mailing address:
  • Phone: 616-541-4496
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number6451022209
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number6451022209
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: