Individual
MICK A SCHOENRADT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LCAC
Contact information
Practice address
1116 N 16TH ST, LAFAYETTE, IN 47904-2119
(765) 423-6300
Mailing address
1116 N 16TH ST, LAFAYETTE, IN 47904-2119
(765) 423-6300
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
87001164A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
87001164
LICENSE
IN
Enumeration date
12/04/2017
Last updated
12/04/2017
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