Provider Demographics
NPI:1184690422
Name:SCHMIDT, BRENDA KAY (RN MA NCC LPC)
Entity Type:Individual
Prefix:
First Name:BRENDA
Middle Name:KAY
Last Name:SCHMIDT
Suffix:
Gender:F
Credentials:RN MA NCC LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:407 TANGLEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:PERRYVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:63775-9771
Mailing Address - Country:US
Mailing Address - Phone:573-547-9963
Mailing Address - Fax:573-547-3063
Practice Address - Street 1:407 TANGLEWOOD DR
Practice Address - Street 2:
Practice Address - City:PERRYVILLE
Practice Address - State:MO
Practice Address - Zip Code:63775-9771
Practice Address - Country:US
Practice Address - Phone:573-547-9963
Practice Address - Fax:573-547-3063
Is Sole Proprietor?:No
Enumeration Date:2006-02-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2000167858101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO133441OtherBLUECROSS/BLUE SHIELD