Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101YA0400X | Addiction Counselor (Substance Use Disorder) | ||
Y | 1041C0700X | Clinical Social Worker | 34006588A | IN |
NPI | 1003169913 |
---|---|
Provider Name | Mr. Michael J Schrettenbrunner |
First Address | Indianapolis, IN 46205 |
Second Address | Indianapolis, IN 46205-1564 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/10/2012 |
Last Update Date | 10/10/2016 |