Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YP2500X | Professional Counselor | 4104 | LA |
NPI | 1003124546 |
---|---|
Provider Name | Michael Schroeder |
First Address | Shreveport, LA 71101-4243 |
Second Address | Shreveport, LA 71101-4243 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/09/2010 |
Last Update Date | 17/09/2010 |