MEDICARE: DR. JOANNE KAREN SCHOUTEN I PH.D.

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	103TC0700X	Clinical Psychologist	6301006461	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	107553	OTHER	MI	VALUE OPTIONS
2	290511000	OTHER	MI	MAGELLAN MIS#
3	4625010	OTHER	MI	AETNA PIN#
4	0-F3-3157	OTHER	MI	BCBS-M

General Provider Information

NPI Number	:	1093705923
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOANNE KAREN SCHOUTEN I PH.D.

Provider Business Mailing Address
First Line	:	18450 RIVERSIDE DR
Second Line	:
City	:	BEVERLY HILLS
State	:	MI
Zip	:	48025-3125
Country	:	US
Telephone Number	:	248-563-9825
Fax Number	:	248-566-3036

Provider Business Practice Location Address
First Line	:	18450 RIVERSIDE DR
Second Line	:
City	:	BEVERLY HILLS
State	:	MI
Zip	:	48025-3125
Country	:	US
Telephone Number	:	248-563-9825
Fax Number	:	248-566-3036

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

Provider Enumeration Date	:	10/22/2005
Last Update Date	:	07/25/2024

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