Basic Information
| Provider Information | |||||||||
| NPI: | 1972671865 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SCHLUCKBIER | ||||||||
| FirstName: | DANIEL | ||||||||
| MiddleName: | JOHN | ||||||||
| NamePrefix: | MR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | LLPC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 58755 VIRGINA CIRCLE | ||||||||
| Address2: | |||||||||
| City: | NEW HAVEN | ||||||||
| State: | MI | ||||||||
| PostalCode: | 48048 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5864193356 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 15945 CANAL | ||||||||
| Address2: | CATHOLIC SERVICES OF MACOMB | ||||||||
| City: | CLINTON TOWNSHIP | ||||||||
| State: | MI | ||||||||
| PostalCode: | 48038 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5864162300 | ||||||||
| FaxNumber: | 5864162311 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/01/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101Y00000X | 6401010179 | MI | Y | Behavioral Health & Social Service Providers | Counselor |
No ID Information.