Healthcare Provider Details

I. General information

NPI: 1902940232
Provider Name (Legal Business Name): MARY JANE SCHREUR LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/19/2007
Last Update Date: 06/23/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40 JEFFERSON AVE SE
GRAND RAPIDS MI
49503-4304
US

IV. Provider business mailing address

381 BLUE ISLE DR
HOLLAND MI
49424-1397
US

V. Phone/Fax

Practice location:
  • Phone: 616-356-6285
  • Fax: 616-732-6392
Mailing address:
  • Phone: 616-786-3896
  • Fax: 616-786-3896

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number6401008621
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: