MEDICARE: DR. MARY JO SCHNELLER PH.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP1600X	Pastoral Counselor	SC9C08A	FL

General Provider Information

NPI Number	:	1538586318
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARY JO SCHNELLER PH.D.

Provider Business Mailing Address
First Line	:	315 LEMAY FERRY RD
Second Line	:	SUITE 132
City	:	SAINT LOUIS
State	:	MO
Zip	:	63125-1501
Country	:	US
Telephone Number	:	314-637-7443
Fax Number	:

Provider Business Practice Location Address
First Line	:	315 LEMAY FERRY RD
Second Line	:	SUITE 132
City	:	SAINT LOUIS
State	:	MO
Zip	:	63125-1501
Country	:	US
Telephone Number	:	314-637-7443
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/18/2014
Last Update Date	:	03/18/2014

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