MEDICARE: MRS. MARYJANE SCHREIBER MS, LPC

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	101YP2500X	Professional Counselor	12143	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2507LC	OTHER	TX	BCBS PROVIDER NUMBER

General Provider Information

NPI Number	:	1740351998
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MARYJANE SCHREIBER MS, LPC

Provider Business Mailing Address
First Line	:	13802 SHAVANO DOWNS
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78230-5812
Country	:	US
Telephone Number	:	210-479-1577
Fax Number	:

Provider Business Practice Location Address
First Line	:	6800 PARK TEN BLVD
Second Line	:	SUITE 298 WEST
City	:	SAN ANTONIO
State	:	TX
Zip	:	78213-4211
Country	:	US
Telephone Number	:	210-737-2039
Fax Number	:	210-737-1396

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

Provider Enumeration Date	:	11/10/2006
Last Update Date	:	07/08/2007

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