Healthcare Provider Details

I. General information

NPI: 1922681493
Provider Name (Legal Business Name): SCOTT D SCHNELLE LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/03/2021
Last Update Date: 12/19/2025
Certification Date: 12/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 N MAIN ST
GRAVOIS MILLS MO
65037-6253
US

IV. Provider business mailing address

PO BOX 777
RICHLAND MO
65556-0777
US

V. Phone/Fax

Practice location:
  • Phone: 877-406-2662
  • Fax:
Mailing address:
  • Phone: 877-406-2662
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number2023042956
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: