Healthcare Provider Details

I. General information

NPI: 1295073690
Provider Name (Legal Business Name): ANNE LOUISE SCHRAUTH MCAP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/21/2013
Last Update Date: 02/06/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

463142 STATE ROAD 200
YULEE FL
32097-5554
US

IV. Provider business mailing address

463142 STATE ROAD 200
YULEE FL
32097-5554
US

V. Phone/Fax

Practice location:
  • Phone: 904-225-8280
  • Fax:
Mailing address:
  • Phone: 904-225-8280
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberMCAP100460
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number6860
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: