Provider Demographics
NPI:1326651837
Name:SCHNELL, AUSTIN KRISTOPHER (LMSW; MSW U/S)
Entity Type:Individual
Prefix:MR
First Name:AUSTIN
Middle Name:KRISTOPHER
Last Name:SCHNELL
Suffix:
Gender:M
Credentials:LMSW; MSW U/S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 N 4TH ST
Mailing Address - Street 2:
Mailing Address - City:PONCA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:74601-4527
Mailing Address - Country:US
Mailing Address - Phone:580-749-5056
Mailing Address - Fax:580-215-5765
Practice Address - Street 1:110 N 4TH ST
Practice Address - Street 2:
Practice Address - City:PONCA CITY
Practice Address - State:OK
Practice Address - Zip Code:74601-4527
Practice Address - Country:US
Practice Address - Phone:580-749-5056
Practice Address - Fax:580-215-5765
Is Sole Proprietor?:No
Enumeration Date:2020-08-25
Last Update Date:2021-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK7521104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK999987654321Medicaid