Healthcare Provider Details

I. General information

NPI: 1457447161
Provider Name (Legal Business Name): HERBERT ARTHUR SCHWAGER PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/04/2006
Last Update Date: 05/25/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

203 N MANZANITA DR # B
PAYSON AZ
85541-4417
US

IV. Provider business mailing address

203 N MANZANITA DR # B
PAYSON AZ
85541-4417
US

V. Phone/Fax

Practice location:
  • Phone: 928-474-6617
  • Fax: 928-474-7059
Mailing address:
  • Phone: 928-474-6617
  • Fax: 928-474-7059

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number582
License Number StateAK
# 2
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number0628
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: