Healthcare Provider Details

I. General information

NPI: 1902195118
Provider Name (Legal Business Name): RYAN NEIL SCHMIDT LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/29/2011
Last Update Date: 11/23/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

425 N MAIN ST STE B
SIMPSONVILLE SC
29681-2062
US

IV. Provider business mailing address

PO BOX 21
SIMPSONVILLE SC
29681-0021
US

V. Phone/Fax

Practice location:
  • Phone: 864-735-5228
  • Fax:
Mailing address:
  • Phone: 864-735-5228
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number5255
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License NumberAN 469600
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: