Provider Demographics
NPI:1902940232
Name:SCHREUR, MARY JANE (LPC)
Entity Type:Individual
Prefix:MS
First Name:MARY
Middle Name:JANE
Last Name:SCHREUR
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:381 BLUE ISLE DR
Mailing Address - Street 2:
Mailing Address - City:HOLLAND
Mailing Address - State:MI
Mailing Address - Zip Code:49424-1397
Mailing Address - Country:US
Mailing Address - Phone:616-786-3896
Mailing Address - Fax:616-786-3896
Practice Address - Street 1:40 JEFFERSON AVE SE
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49503-4304
Practice Address - Country:US
Practice Address - Phone:616-356-6285
Practice Address - Fax:616-732-6392
Is Sole Proprietor?:No
Enumeration Date:2007-02-19
Last Update Date:2008-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401008621101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI7509106890OtherBLUE CROSS BLUE SHIELD