Provider Demographics
NPI:1942749825
Name:DEPETER-SCHULZ, LYNETTE (MA, LMSW)
Entity type:Individual
Prefix:
First Name:LYNETTE
Middle Name:
Last Name:DEPETER-SCHULZ
Suffix:
Gender:F
Credentials:MA, LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:217 S HURON ST
Mailing Address - Street 2:
Mailing Address - City:CHEBOYGAN
Mailing Address - State:MI
Mailing Address - Zip Code:49721-1919
Mailing Address - Country:US
Mailing Address - Phone:231-445-1691
Mailing Address - Fax:231-363-5916
Practice Address - Street 1:217 S HURON ST
Practice Address - Street 2:
Practice Address - City:CHEBOYGAN
Practice Address - State:MI
Practice Address - Zip Code:49721-1919
Practice Address - Country:US
Practice Address - Phone:231-445-1691
Practice Address - Fax:231-363-5916
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-13
Last Update Date:2018-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010852021041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical