Basic Information
| Provider Information | |||||||||
| NPI: | 1215483805 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SCHRAM | ||||||||
| FirstName: | NICOLE | ||||||||
| MiddleName: | RYAN | ||||||||
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| Credential: | LPC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3785 BAY RD | ||||||||
| Address2: | |||||||||
| City: | SAGINAW | ||||||||
| State: | MI | ||||||||
| PostalCode: | 486032433 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9897912455 | ||||||||
| FaxNumber: | 9897911392 | ||||||||
| Practice Location | |||||||||
| Address1: | 720 W WACKERLY ST STE 11 | ||||||||
| Address2: | |||||||||
| City: | MIDLAND | ||||||||
| State: | MI | ||||||||
| PostalCode: | 486402769 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9898322165 | ||||||||
| FaxNumber: | 9898394376 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/01/2016 | ||||||||
| LastUpdateDate: | 10/01/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101Y00000X | 6401015516 | MI | Y | Behavioral Health & Social Service Providers | Counselor |
No ID Information.