Healthcare Provider Details

I. General information

NPI: 1760683254
Provider Name (Legal Business Name): PHYLLIS SCHNELL R.N., L.P.C., M.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/30/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

106 FARRAR DR SUITE 109
CAPE GIRARDEAU MO
63701-4902
US

IV. Provider business mailing address

137 S LOUISIANA ST
CAPE GIRARDEAU MO
63703-6008
US

V. Phone/Fax

Practice location:
  • Phone: 573-334-7055
  • Fax: 573-334-7961
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number002637
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: