Healthcare Provider Details

I. General information

NPI: 1144483868
Provider Name (Legal Business Name): FRANK SCHAEFER LAC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/02/2008
Last Update Date: 09/11/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6301 19TH AVE NW
MINOT ND
58703
US

IV. Provider business mailing address

PO BOX 5007
MINOT ND
58702-5007
US

V. Phone/Fax

Practice location:
  • Phone: 701-858-0115
  • Fax: 701-852-1190
Mailing address:
  • Phone: 701-858-0115
  • Fax: 701-852-1190

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number1338
License Number StateND

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier75007
Identifier TypeMEDICAID
Identifier StateND
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: