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General NPI Number Information
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NPI Number | 1629108261
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Entity Type | Organization
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Legal Business Name | PARK PLACE PSYCHIATRY, LLC
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Dates
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Enumeration Date | 03/06/2007
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Last Update Date | 06/14/2013
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Provider Practice Location Address
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Address Line | 207 WINTON M. BLOUNT LOOP
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City | MONTGOMERY
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State | AL
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Zip | 36117
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Country | US
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Telephone | 334-356-1417
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Fax | 334-356-1433
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Provider Business Mailing Address
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Address Line | P.O. BOX 241486
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City | MONTGOMERY
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State | AL
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Zip | 36124-1486
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Country | US
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Telephone | 334-356-1417
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Fax | 334-356-1433
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Authorized Official
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Title or Position | OWNER
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Name | MR. DAVID D. SCHAFTER
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Credential | D.O., PH.D.
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Telephone | 334-356-1417
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 1452
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License Number State | AL
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 2914
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License Number State | AL
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Taxonomy #3
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 2914
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License Number State | AL
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Taxonomy #4
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | D0421
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License Number State | AL
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