Provider Demographics
NPI:1417416967
Name:SCHMIDT, GERARD JOSEPH (MA, LPC, MAC)
Entity Type:Individual
Prefix:MR
First Name:GERARD
Middle Name:JOSEPH
Last Name:SCHMIDT
Suffix:
Gender:M
Credentials:MA, LPC, MAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 TIGER TRL
Mailing Address - Street 2:
Mailing Address - City:FAIRMONT
Mailing Address - State:WV
Mailing Address - Zip Code:26554-7945
Mailing Address - Country:US
Mailing Address - Phone:304-376-3648
Mailing Address - Fax:
Practice Address - Street 1:4579 BUCKHANNON PIKE STE 101
Practice Address - Street 2:
Practice Address - City:MOUNT CLARE
Practice Address - State:WV
Practice Address - Zip Code:26408-7176
Practice Address - Country:US
Practice Address - Phone:304-622-6404
Practice Address - Fax:304-622-6404
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-14
Last Update Date:2019-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV330101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional