Healthcare Provider Details

I. General information

NPI: 1871715912
Provider Name (Legal Business Name): LAWRENCE G SCHMIDT M.A.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/02/2007
Last Update Date: 01/17/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2075 W BIG BEAVER RD 520
TROY MI
48084
US

IV. Provider business mailing address

3100 E OAKWOOD RD
OXFORD MI
48370-1014
US

V. Phone/Fax

Practice location:
  • Phone: 248-646-6659
  • Fax: 248-642-8645
Mailing address:
  • Phone: 248-969-9399
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number6301012474
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: