=====================================================
General NPI Number Information
=====================================================
NPI Number | 1508339912
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CHARLES KYLE SCHINDLER PHD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/08/2019
-----------------------------------------------------
Last Update Date | 01/08/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1003 FLINT AVE RM 201
-----------------------------------------------------
City | LUBBOCK
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 79409-9803
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 806-834-8071
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6610 34TH ST APT 1923
-----------------------------------------------------
City | LUBBOCK
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 79407-2857
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 979-966-8041
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103TC1900X
-----------------------------------------------------
Taxonomy Name | Counseling Psychologist
-----------------------------------------------------
License Number | 37679
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------