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NPI Code Detail

MEDICARE: DR. SUSAN LEE SCHMID PSY.D.

MEDICARE: DR. SUSAN LEE SCHMID PSY.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
1103TC0700XClinical Psychologist23876TX

General Provider Information

NPI Number : 1821182007
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. SUSAN LEE SCHMID PSY.D.
Provider Business Mailing Address
First Line : 400 RICE AVE
Second Line :
City : WACO
State : TX
Zip : 76708-2269
Country : US
Telephone Number : 254-757-0734
Fax Number :
Provider Business Practice Location Address
First Line : 3501 N 19TH ST
Second Line :
City : WACO
State : TX
Zip : 76708-2007
Country : US
Telephone Number : 254-745-5321
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/03/2006
Last Update Date : 07/08/2007

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