Healthcare Provider Details

I. General information

NPI: 1184690422
Provider Name (Legal Business Name): BRENDA KAY SCHMIDT RN MA NCC LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/27/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

407 TANGLEWOOD DR
PERRYVILLE MO
63775-9771
US

IV. Provider business mailing address

407 TANGLEWOOD DR
PERRYVILLE MO
63775-9771
US

V. Phone/Fax

Practice location:
  • Phone: 573-547-9963
  • Fax: 573-547-3063
Mailing address:
  • Phone: 573-547-9963
  • Fax: 573-547-3063

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number2000167858
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: