MEDICARE: DANIEL D SCHRECK PHD

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	101YP1600X	Pastoral Counselor	2081776	IN
2	101YA0400X	Addiction (Substance Use Disorder) Counselor	87000235A	IN

General Provider Information

NPI Number	:	1861741043
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DANIEL D SCHRECK PHD

Provider Business Mailing Address
First Line	:	2112 INWOOD DR
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46815-7115
Country	:	US
Telephone Number	:	260-218-8299
Fax Number	:

Provider Business Practice Location Address
First Line	:	2112 INWOOD DR
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46815-7115
Country	:	US
Telephone Number	:	260-218-8299
Fax Number	:

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

Provider Enumeration Date	:	09/05/2012
Last Update Date	:	04/02/2021

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