Provider Demographics
NPI:1144416322
Name:SCHUBERT, CARRIE G (LPC)
Entity Type:Individual
Prefix:
First Name:CARRIE
Middle Name:G
Last Name:SCHUBERT
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:CARRIE
Other - Middle Name:G
Other - Last Name:MASTRONARDE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:17 E SAINT JOSEPH ST
Mailing Address - Street 2:
Mailing Address - City:PERRYVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:63775-2016
Mailing Address - Country:US
Mailing Address - Phone:573-517-3951
Mailing Address - Fax:866-517-0663
Practice Address - Street 1:17 E SAINT JOSEPH ST
Practice Address - Street 2:
Practice Address - City:PERRYVILLE
Practice Address - State:MO
Practice Address - Zip Code:63775-2016
Practice Address - Country:US
Practice Address - Phone:573-517-3951
Practice Address - Fax:866-517-0663
Is Sole Proprietor?:No
Enumeration Date:2007-09-20
Last Update Date:2022-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2006009196101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO490788601Medicaid
MO11990734OtherCAQH