Healthcare Provider Details

I. General information

NPI: 1205993441
Provider Name (Legal Business Name): MICHAEL SCHWAB LISW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/03/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

922 W. RIVERVIEW AVE.
DAYTON OH
45402
US

IV. Provider business mailing address

922 W RIVERVIEW AVE
DAYTON OH
45402-6424
US

V. Phone/Fax

Practice location:
  • Phone: 937-296-1007
  • Fax:
Mailing address:
  • Phone: 937-296-1007
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberI-0004696
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberI-0004696
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberI-0004696
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: