MEDICARE: PHYLLIS SCHNELL R.N., L.P.C., M.A.

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	002637	MO

General Provider Information

NPI Number	:	1760683254
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PHYLLIS SCHNELL R.N., L.P.C., M.A.

Provider Business Mailing Address
First Line	:	137 S LOUISIANA ST
Second Line	:
City	:	CAPE GIRARDEAU
State	:	MO
Zip	:	63703-6008
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	106 FARRAR DR
Second Line	:	SUITE 109
City	:	CAPE GIRARDEAU
State	:	MO
Zip	:	63701-4902
Country	:	US
Telephone Number	:	573-334-7055
Fax Number	:	573-334-7961

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

Provider Enumeration Date	:	05/30/2007
Last Update Date	:	07/08/2007

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