=====================================================
General NPI Number Information
=====================================================
NPI Number | 1255610838
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SHALISE M. SCHNITZ, LCSW , PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/12/2011
-----------------------------------------------------
Last Update Date | 05/24/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 20079 STONE OAK PKWY STE 1240
-----------------------------------------------------
City | SAN ANTONIO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78258-6980
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 210-560-8015
-----------------------------------------------------
Fax | 210-403-2722
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 20079 STONE OAK PKWY STE 1240
-----------------------------------------------------
City | SAN ANTONIO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78258-6980
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 210-560-8015
-----------------------------------------------------
Fax | 210-403-2722
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MRS. SHALISE MONAIE SCHNITZ
-----------------------------------------------------
Credential | LCSW
-----------------------------------------------------
Telephone | 210-560-8015
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | 33664
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------