Healthcare Provider Details

I. General information

NPI: 1891858544
Provider Name (Legal Business Name): VIRGINIA B SCHENCK LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MISS VIRGINIA B HARRIS

II. Dates (important events)

Enumeration Date: 12/17/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

734 W MONROE ST
MEXICO MO
65265-1970
US

IV. Provider business mailing address

304 ROANOKE DR
WARRENTON MO
63383-1310
US

V. Phone/Fax

Practice location:
  • Phone: 573-582-0292
  • Fax: 573-581-6036
Mailing address:
  • Phone: 636-456-8144
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number2002020611
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: