Provider Demographics
NPI:1093705923
Name:SCHOUTEN, JOANNE KAREN I (PHD)
Entity type:Individual
Prefix:DR
First Name:JOANNE
Middle Name:KAREN
Last Name:SCHOUTEN
Suffix:I
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18450 RIVERSIDE DR
Mailing Address - Street 2:
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48025-3125
Mailing Address - Country:US
Mailing Address - Phone:248-563-9825
Mailing Address - Fax:248-566-3036
Practice Address - Street 1:18450 RIVERSIDE DR
Practice Address - Street 2:
Practice Address - City:BEVERLY HILLS
Practice Address - State:MI
Practice Address - Zip Code:48025-3125
Practice Address - Country:US
Practice Address - Phone:248-563-9825
Practice Address - Fax:248-566-3036
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-22
Last Update Date:2024-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301006461103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI107553OtherVALUE OPTIONS
MI290511000OtherMAGELLAN MIS#
MI4625010OtherAETNA PIN#
MI0-F3-3157OtherBCBS-M
MI0-F3-3157OtherBCBS-M
MI107553OtherVALUE OPTIONS