Provider Demographics
NPI:1316089006
Name:SCHAEFER, MICHAEL (MFT)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:SCHAEFER
Suffix:
Gender:M
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12440 FIRESTONE BLVD
Mailing Address - Street 2:# 3025
Mailing Address - City:NORWALK
Mailing Address - State:CA
Mailing Address - Zip Code:90650
Mailing Address - Country:US
Mailing Address - Phone:562-929-6688
Mailing Address - Fax:562-929-9074
Practice Address - Street 1:12440 FIRESTONE BLVD
Practice Address - Street 2:SUITE 3025
Practice Address - City:NORWALK
Practice Address - State:CA
Practice Address - Zip Code:90650-4328
Practice Address - Country:US
Practice Address - Phone:562-929-6688
Practice Address - Fax:562-929-3868
Is Sole Proprietor?:No
Enumeration Date:2007-02-12
Last Update Date:2011-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFT27493106H00000X
106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA7250AOtherACT 7