Healthcare Provider Details

I. General information

NPI: 1568764355
Provider Name (Legal Business Name): DUANE MINNILLEE SCHOONARD MA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/30/2010
Last Update Date: 11/30/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4829 COLLEGE DRIVE, EAST
COLLEGEDALE TN
37315
US

IV. Provider business mailing address

5129 SILVER LN
APISON TN
37302-9594
US

V. Phone/Fax

Practice location:
  • Phone: 423-396-2134
  • Fax: 423-396-9509
Mailing address:
  • Phone: 423-396-2134
  • Fax: 423-396-9509

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLPC0000001577
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: