Provider Demographics
NPI:1962584615
Name:SCHAFER, LOIS (PHD)
Entity type:Individual
Prefix:DR
First Name:LOIS
Middle Name:
Last Name:SCHAFER
Suffix:
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 1:42627 GARFIELD RD
Mailing Address - Street 2:SUITE 216-C
Mailing Address - City:CLINTON TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48038-5032
Mailing Address - Country:US
Mailing Address - Phone:586-246-5164
Mailing Address - Fax:844-621-4391
Practice Address - Street 1:42627 GARFIELD RD
Practice Address - Street 2:SUITE 216-C
Practice Address - City:CLINTON TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48038-5032
Practice Address - Country:US
Practice Address - Phone:586-246-5164
Practice Address - Fax:844-621-4391
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-20
Last Update Date:2015-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301008020103T00000X, 103TC0700X, 103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI143624OtherPRIORITY HEALTH
MIP111686OtherBLUE CROSS NETWORK OF MI
MI11409OtherM-CARE
MI680E04600OtherBLUE CROSS BLUE SHEILD MI
MIG2157173OtherVALUE OPTIONS
MIMI1440Medicare UPIN
MIP111686OtherBLUE CROSS NETWORK OF MI