Provider Demographics
NPI:1215230602
Name:HENRY D. SCHNEIDER, PH.D., LCSW, INC.
Entity Type:Organization
Organization Name:HENRY D. SCHNEIDER, PH.D., LCSW, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED CLINICAL SOCIAL WORKER
Authorized Official - Prefix:DR
Authorized Official - First Name:HENRY
Authorized Official - Middle Name:D
Authorized Official - Last Name:SCHNEIDER
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, LCSW
Authorized Official - Phone:573-446-6290
Mailing Address - Street 1:2804 FORUM BLVD
Mailing Address - Street 2:3A
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65203-6322
Mailing Address - Country:US
Mailing Address - Phone:573-446-6290
Mailing Address - Fax:573-446-0618
Practice Address - Street 1:2804 FORUM BLVD
Practice Address - Street 2:3A
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65203-6322
Practice Address - Country:US
Practice Address - Phone:573-446-6290
Practice Address - Fax:573-446-0618
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-07
Last Update Date:2010-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO000600261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO756819504Medicaid