MEDICARE: MR. MICHAEL SCHROEDER MFT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106H00000X	Marriage & Family Therapist	44527	CA

General Provider Information

NPI Number	:	1083850556
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. MICHAEL SCHROEDER MFT

Provider Business Mailing Address
First Line	:	20350 VENTURA BLVD
Second Line	:	SUITE 230
City	:	WOODLAND HILLS
State	:	CA
Zip	:	91364-2452
Country	:	US
Telephone Number	:	818-226-6070
Fax Number	:	818-704-8948

Provider Business Practice Location Address
First Line	:	20350 VENTURA BLVD
Second Line	:	SUITE 230
City	:	WOODLAND HILLS
State	:	CA
Zip	:	91364-2452
Country	:	US
Telephone Number	:	818-226-6070
Fax Number	:	818-704-8948

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/05/2009
Last Update Date	:	01/05/2009

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